Provider Demographics
NPI:1598472813
Name:CHALKER, JEAN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:CHALKER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:MAGNUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2768 E BIRCH RUN RD
Mailing Address - Street 2:
Mailing Address - City:BURT
Mailing Address - State:MI
Mailing Address - Zip Code:48417-9404
Mailing Address - Country:US
Mailing Address - Phone:989-213-2115
Mailing Address - Fax:
Practice Address - Street 1:12167 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-7935
Practice Address - Country:US
Practice Address - Phone:810-591-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist