Provider Demographics
NPI:1790746634
Name:CHIAVOLA, JAIME LYNN (SLP)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:LYNN
Last Name:CHIAVOLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 FALDO LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-8938
Mailing Address - Country:US
Mailing Address - Phone:252-571-2078
Mailing Address - Fax:252-637-4812
Practice Address - Street 1:3305 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-6929
Practice Address - Country:US
Practice Address - Phone:252-571-2078
Practice Address - Fax:252-637-4812
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412399Medicaid
NC11998639OtherTRICARE
NC141A9OtherBC