Provider Demographics
NPI:1356689798
Name:VANCLEAVE, SHARON (SLP/CCC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CHESTNUT WOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4502
Mailing Address - Country:US
Mailing Address - Phone:423-991-2500
Mailing Address - Fax:
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2285
Practice Address - Country:US
Practice Address - Phone:423-894-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist