Provider Demographics
NPI:1235318619
Name:PRICE, CHERYL MOODY (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MOODY
Last Name:PRICE
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 EDGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7456
Mailing Address - Country:US
Mailing Address - Phone:803-331-1560
Mailing Address - Fax:
Practice Address - Street 1:1746 EDGE PARK RD
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-7456
Practice Address - Country:US
Practice Address - Phone:803-331-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4221235Z00000X
NC7923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0841Medicaid