Provider Demographics
NPI:1538253323
Name:WAXMAN, CHERRIE R (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHERRIE
Middle Name:R
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3424
Mailing Address - Country:US
Mailing Address - Phone:207-594-5933
Mailing Address - Fax:207-594-1925
Practice Address - Street 1:116 TILLSON AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3424
Practice Address - Country:US
Practice Address - Phone:207-594-5933
Practice Address - Fax:207-594-1925
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1920235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME12429000OtherMAINECARE