Provider Demographics
NPI:1932403979
Name:CHEFER, MIRIAM S (MA SLP)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:S
Last Name:CHEFER
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 MOORINGS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-7510
Mailing Address - Country:US
Mailing Address - Phone:904-260-9797
Mailing Address - Fax:
Practice Address - Street 1:3745 MOORINGS LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-7510
Practice Address - Country:US
Practice Address - Phone:904-260-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist