Provider Demographics
NPI:1255093324
Name:TIGNOR, CHANELLE ELISE (CFY-SLP)
Entity type:Individual
Prefix:
First Name:CHANELLE
Middle Name:ELISE
Last Name:TIGNOR
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 PINEHURST PARK DR APT 28211
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4915
Mailing Address - Country:US
Mailing Address - Phone:704-684-3096
Mailing Address - Fax:
Practice Address - Street 1:307 W TREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4902
Practice Address - Country:US
Practice Address - Phone:704-684-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist