Healthcare Provider Details

I. General information

NPI: 1356842983
Provider Name (Legal Business Name): CHERRI HARTZOG CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCOTTSVILLE ELEMENTARY 7868 SCOTTSVILLE RD
SCOTTSVILLE VA
24590
US

IV. Provider business mailing address

SCOTTSVILLE ELEMENTARY 7868 SCOTTSVILLE RD
SCOTTSVILLE VA
24590
US

V. Phone/Fax

Practice location:
  • Phone: 434-974-8040
  • Fax:
Mailing address:
  • Phone: 434-974-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002646
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: