Provider Demographics
NPI:1902287642
Name:STONE, CHEYENNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 N MOON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7903
Mailing Address - Country:US
Mailing Address - Phone:812-791-2938
Mailing Address - Fax:
Practice Address - Street 1:1707 N SHELBY ST STE 118
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-5882
Practice Address - Country:US
Practice Address - Phone:812-791-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006109A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist