Basic Information
| Provider Information | |||||||||
| NPI: | 1376869503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STILLSON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2719 WINDING RUN LN | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774944649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817332803 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1240 BLALOCK RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770556443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 04/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 18479 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.