Carly Ann Cheatham

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

C350-1019-7862 Issued in IL

Practice address

4450 N Prospect Rd Ste C5
Peoria Heights, IL 61616-6578

Phone

(309) 363-7594

Fax

(309) 966-3621

NPI assigned

Jun 24, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Saint Francis Medical Center

  • Home Health Agency
  • Peoria, IL
  • NPI 1346281425
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1386376820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S MISSOURI AVE UNIT 3",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615509028",
            "telephone_number": "217-706-0491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 N PROSPECT RD STE C5",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616166578",
            "telephone_number": "309-363-7594",
            "fax_number": "309-966-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEATHAM",
        "first_name": "CARLY",
        "middle_name": "ANN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-24",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "C350-1019-7862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "C350-1019-7862",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@waytogrowpediatrics.com",
            "affiliation": "N",
            "endpointDescription": "office@waytogrowpediatrics.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4450 N Prospect Rd Ste C5",
            "city": "Peoria Heights",
            "state": "IL",
            "country_code": "US",
            "postal_code": "616166578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• By Faith Counseling PLLC
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• Sandra Kay Chatwood, MA LMFT LCPC
• Jonathon Ross Closen, PHARMD
• Clove Dental PLLC
• Kristin Kathryn Cochran, COTA/L
• Amanda M Crusen, LCSW
• Stephen C Doughty, MD

• Speech-Language Pathologist in Peoria Heights, IL
• Providers in Peoria Heights, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.