Provider Demographics
NPI:1902440092
Name:CHEEKS, SHELLEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CHEEKS
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 1:1995 OLD LEBANON DIRT RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7416
Mailing Address - Country:US
Mailing Address - Phone:615-828-3135
Mailing Address - Fax:
Practice Address - Street 1:754 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3950
Practice Address - Country:US
Practice Address - Phone:615-754-2828
Practice Address - Fax:615-754-2818
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist