Provider Demographics
NPI:1487823373
Name:CHAUDRON, DONNA D (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:D
Last Name:CHAUDRON
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 1:332 E SPRINGBROOK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1767
Mailing Address - Country:US
Mailing Address - Phone:423-483-8588
Mailing Address - Fax:734-827-3858
Practice Address - Street 1:332 EAST SPRINGBROOK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-483-8588
Practice Address - Fax:734-827-3858
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000003345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000003345OtherTN STATE LICENSE
1487823373OtherNPI
01032035OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION