Provider Demographics
NPI:1093903460
Name:HIGGS, CHAD L (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:L
Last Name:HIGGS
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 BAYBERRY LN NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-6502
Mailing Address - Country:US
Mailing Address - Phone:423-260-8313
Mailing Address - Fax:
Practice Address - Street 1:2950 BAYBERRY LN NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6502
Practice Address - Country:US
Practice Address - Phone:423-260-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5886235Z00000X
VA2202004079235Z00000X
TN3788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8108Medicaid
TNQ023990Medicaid