Provider Demographics
NPI:1558695619
Name:JAMES, CHANEL W (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:W
Last Name:JAMES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 CLINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9309
Mailing Address - Country:US
Mailing Address - Phone:336-816-6336
Mailing Address - Fax:
Practice Address - Street 1:3637 CLINEDALE RD
Practice Address - Street 2:
Practice Address - City:PFAFFTOWN
Practice Address - State:NC
Practice Address - Zip Code:27040-9309
Practice Address - Country:US
Practice Address - Phone:336-816-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist