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NPI Code Detail

MEDICARE: CHERYL RENEE CARTER PSYD

MEDICARE: CHERYL RENEE CARTER PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071009395IL

General Provider Information

NPI Number : 1467902130
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL RENEE CARTER PSYD
Provider Business Mailing Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 309-706-3190
Fax Number : 309-588-4115
Provider Business Practice Location Address
First Line : 808 S ELDORADO RD STE 102
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-6075
Country : US
Telephone Number : 309-706-3190
Fax Number : 309-588-4115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2016
Last Update Date : 10/06/2016

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Directions to “ CHERYL RENEE CARTER PSYD” Practice Location

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