Healthcare Provider Details

I. General information

NPI: 1639424302
Provider Name (Legal Business Name): CHERYL GESSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4390 BELLE OAKS DR SUITE 120
N CHARLESTON SC
29405-8559
US

IV. Provider business mailing address

4390 BELLE OAKS DR SUITE 120
N CHARLESTON SC
29405-8559
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-2700
  • Fax:
Mailing address:
  • Phone: 843-571-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3425
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: