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General NPI Number Information
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NPI Number | 1063562452
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Entity Type | Individual
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Provider Name | ERNEST ALFRED CHERULLO III SPEECH PATHOLOGIST
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3617 N TRIPP AVE
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City | CHICAGO
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State | IL
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Zip | 60641-3038
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Country | US
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Telephone | 773-727-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 W 104TH ST APT 101A
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City | OAK LAWN
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State | IL
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Zip | 60453-6220
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Country | US
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Telephone | 773-860-9465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | IL
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