Provider Demographics
NPI:1871978163
Name:RAMBLER, CHERYL SUPPES (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUPPES
Last Name:RAMBLER
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 1:2729 RIDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1507
Mailing Address - Country:US
Mailing Address - Phone:404-932-9653
Mailing Address - Fax:
Practice Address - Street 1:2729 RIDERWOOD DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1507
Practice Address - Country:US
Practice Address - Phone:404-932-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist