Provider Demographics
NPI:1457085086
Name:CHAPPELL, MARISSA DANIELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:DANIELLE
Last Name:CHAPPELL
Suffix:
Gender:F
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 1:1305 W WENDOVER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8100
Mailing Address - Country:US
Mailing Address - Phone:336-541-8167
Mailing Address - Fax:336-663-0266
Practice Address - Street 1:1305 W WENDOVER AVE STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8100
Practice Address - Country:US
Practice Address - Phone:336-541-8167
Practice Address - Fax:336-663-0266
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist