Provider Demographics
NPI:1528060761
Name:CHINN, CAROL A (AUD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:CHINN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SE WALTON BLVD
Mailing Address - Street 2:STE 119
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3746
Mailing Address - Country:US
Mailing Address - Phone:479-254-0011
Mailing Address - Fax:479-254-0710
Practice Address - Street 1:1501 SE WALTON BLVD
Practice Address - Street 2:STE 119
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3746
Practice Address - Country:US
Practice Address - Phone:479-254-0011
Practice Address - Fax:479-254-0710
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-170237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U335Medicare ID - Type Unspecified
AR5U335Medicare UPIN