Provider Demographics
NPI:1154529808
Name:CHAUVIN, JENNIFER BROOKE (MCD, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:CHAUVIN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BROOKE
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 E WILLIAM DAVID PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3309
Mailing Address - Country:US
Mailing Address - Phone:504-258-5521
Mailing Address - Fax:
Practice Address - Street 1:22 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3013
Practice Address - Country:US
Practice Address - Phone:985-764-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist