Provider Demographics
NPI:1073960639
Name:MCCOMMON, CHLOE CLARK (MCD)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:CLARK
Last Name:MCCOMMON
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 KIRKSEY DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-3240
Mailing Address - Country:US
Mailing Address - Phone:334-790-6837
Mailing Address - Fax:
Practice Address - Street 1:218 KIRKSEY DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-3240
Practice Address - Country:US
Practice Address - Phone:334-790-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist