Provider Demographics
NPI:1619096492
Name:LOUDERMILL, CHENELL CHENISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHENELL
Middle Name:CHENISE
Last Name:LOUDERMILL
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 1:715 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2122
Mailing Address - Country:US
Mailing Address - Phone:501-407-9488
Mailing Address - Fax:501-407-0515
Practice Address - Street 1:52 WOODRIDGE DR.
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204
Practice Address - Country:US
Practice Address - Phone:501-407-9488
Practice Address - Fax:501-407-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156337721Medicaid