Provider Demographics
NPI:1588895536
Name:CHAVIS, JOHNETTA EMILY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOHNETTA
Middle Name:EMILY
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 PATRIOT WAY
Mailing Address - Street 2:UNIT B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2744
Mailing Address - Country:US
Mailing Address - Phone:336-638-4678
Mailing Address - Fax:
Practice Address - Street 1:2401 PATRIOT WAY
Practice Address - Street 2:UNIT B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2744
Practice Address - Country:US
Practice Address - Phone:336-638-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist