Provider Demographics
NPI:1972803781
Name:GILES, CHANTELE DENAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHANTELE
Middle Name:DENAE
Last Name:GILES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RUBY WAY
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-5450
Mailing Address - Country:US
Mailing Address - Phone:770-584-1174
Mailing Address - Fax:
Practice Address - Street 1:103 RUBY WAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-5450
Practice Address - Country:US
Practice Address - Phone:770-584-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist