Healthcare Provider Details

I. General information

NPI: 1861764094
Provider Name (Legal Business Name): CHITTER CHATTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 09/17/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 STUDBURY HALL CT
WAKE FOREST NC
27587-9800
US

IV. Provider business mailing address

4820 STUDBURY HALL CT
WAKE FOREST NC
27587-9800
US

V. Phone/Fax

Practice location:
  • Phone: 919-609-5643
  • Fax: 919-435-0924
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LUCAS THOMAS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S.
Phone: 919-609-5643