Provider Demographics
NPI:1851790422
Name:CHIRDON, JEANNE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:CHIRDON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3338
Mailing Address - Country:US
Mailing Address - Phone:216-256-9628
Mailing Address - Fax:843-884-6481
Practice Address - Street 1:3100 TRADITION CIR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7200
Practice Address - Country:US
Practice Address - Phone:843-654-7945
Practice Address - Fax:843-884-6481
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist