Provider Demographics
NPI:1336688134
Name:CHEVILLET, SHARON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CHEVILLET
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 1:10640 N TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9581
Mailing Address - Country:US
Mailing Address - Phone:313-971-3576
Mailing Address - Fax:
Practice Address - Street 1:10640 N TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9581
Practice Address - Country:US
Practice Address - Phone:313-971-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist