Provider Demographics
NPI:1306413067
Name:CHETWIN, MONICA RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:CHETWIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 CLOVERLEAF ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5132
Mailing Address - Country:US
Mailing Address - Phone:315-857-5723
Mailing Address - Fax:
Practice Address - Street 1:350 S CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5708
Practice Address - Country:US
Practice Address - Phone:315-857-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist