Basic Information
| Provider Information | |||||||||
| NPI: | 1508091091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DETERMAN | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3761 PILGRIM ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891214445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024586651 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8540 S EASTERN AVE | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891232834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027338255 | ||||||||
| FaxNumber: | 7027378255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 05/27/2009 | ||||||||
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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 | SP1258 | NV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.