Provider Demographics
NPI:1174657126
Name:REED, CHANTELLE R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:R
Last Name:REED
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 1:2092 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3279
Mailing Address - Country:US
Mailing Address - Phone:615-828-9403
Mailing Address - Fax:
Practice Address - Street 1:2092 BROOKSTONE DR
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3279
Practice Address - Country:US
Practice Address - Phone:615-828-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist