Provider Demographics
NPI:1659730596
Name:CHOUARD, JEANNE CAMPBELL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:CAMPBELL
Last Name:CHOUARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1178 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3574
Mailing Address - Country:US
Mailing Address - Phone:541-646-5243
Mailing Address - Fax:
Practice Address - Street 1:1178 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3574
Practice Address - Country:US
Practice Address - Phone:541-646-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist