Provider Demographics
NPI:1134512247
Name:CHIDI, CHIMEZIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHIMEZIE
Middle Name:
Last Name:CHIDI
Suffix:
Gender:F
Credentials:MA,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:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-0165
Mailing Address - Country:US
Mailing Address - Phone:925-759-6519
Mailing Address - Fax:
Practice Address - Street 1:201 SAND CREEK RD STE G4
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2124
Practice Address - Country:US
Practice Address - Phone:925-759-6519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist