Provider Demographics
NPI:1689085938
Name:SHOOP, CHELSEA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SHOOP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 APACHE AVE
Mailing Address - Street 2:APT 121
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2312
Mailing Address - Country:US
Mailing Address - Phone:717-816-8002
Mailing Address - Fax:
Practice Address - Street 1:12300 APACHE AVE
Practice Address - Street 2:APT 121
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2312
Practice Address - Country:US
Practice Address - Phone:717-816-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1363637OtherGEORGIA EDUCATOR CERTIFICATE, GEORGIA PROFESSIONAL STANDARDS COMMISSION