Provider Demographics
NPI:1023371051
Name:CHAPIN, JENNIFER L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CHAPIN
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 1:19 ANSON ST # 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3201
Mailing Address - Country:US
Mailing Address - Phone:617-431-8828
Mailing Address - Fax:617-431-8826
Practice Address - Street 1:19 ANSON ST # 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3201
Practice Address - Country:US
Practice Address - Phone:617-431-8828
Practice Address - Fax:617-431-8826
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3685-154235Z00000X
FLSA13454235Z00000X
MASLP6868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS018FOtherBLUE CROS BLUE SHIELD
FL014401700Medicaid
FLS018FOtherBLUE CROS BLUE SHIELD