Provider Demographics
NPI:1205335452
Name:JORA, CHANTAL
Entity type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:
Last Name:JORA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHANTAL
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14720 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5644
Mailing Address - Country:US
Mailing Address - Phone:518-698-4329
Mailing Address - Fax:
Practice Address - Street 1:101 CLARKE PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6529
Practice Address - Country:US
Practice Address - Phone:301-360-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP200001408235Z00000X
MD10372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist