Provider Demographics
NPI:1518096890
Name:MCCHESNEY, CAROLYN E (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:E
Last Name:MCCHESNEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ANCHOR CT
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2199
Mailing Address - Country:US
Mailing Address - Phone:412-916-1433
Mailing Address - Fax:
Practice Address - Street 1:100 NETHERLAND LN
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7245
Practice Address - Country:US
Practice Address - Phone:423-245-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396648Medicare Oscar/Certification