Provider Demographics
NPI:1194271767
Name:POWELL, CHARIS RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:RENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CHARIS
Other - Middle Name:RENEE
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13807 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13807 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1783
Practice Address - Country:US
Practice Address - Phone:806-993-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMJ840015547OtherPPO