Provider Demographics
NPI:1750195129
Name:HIBBS, CHLOE AUTUMN
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:AUTUMN
Last Name:HIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EDEN TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26763-9518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2160
Practice Address - Country:US
Practice Address - Phone:304-933-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty