Provider Demographics
NPI:1811231343
Name:PAUL, CHARLES JASON (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JASON
Last Name:PAUL
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 JUNIPER DR APT 190
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3448
Mailing Address - Country:US
Mailing Address - Phone:248-563-6919
Mailing Address - Fax:
Practice Address - Street 1:1732 JUNIPER DR APT 190
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3448
Practice Address - Country:US
Practice Address - Phone:248-563-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist