Provider Demographics
NPI:1558485243
Name:MICKENS, CHASATTEE (SLP)
Entity Type:Individual
Prefix:
First Name:CHASATTEE
Middle Name:
Last Name:MICKENS
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 1:307 UPTON ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1735
Mailing Address - Country:US
Mailing Address - Phone:336-837-4222
Mailing Address - Fax:336-376-7711
Practice Address - Street 1:307 UPTON ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1735
Practice Address - Country:US
Practice Address - Phone:336-837-4222
Practice Address - Fax:336-376-7711
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist