Provider Demographics
NPI:1578621090
Name:CHASTAIN, JENNIFER CREWS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CREWS
Last Name:CHASTAIN
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 1:102 W OAKCREST RD
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30541-2245
Mailing Address - Country:US
Mailing Address - Phone:706-964-1250
Mailing Address - Fax:
Practice Address - Street 1:448 WELLBORN ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3548
Practice Address - Country:US
Practice Address - Phone:706-745-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist