Healthcare Provider Details

I. General information

NPI: 1154942498
Provider Name (Legal Business Name): CHLOE GABRIELLE TRAVE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

974 WOODCREST DR
KEYPORT NJ
07735-5342
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone: 609-214-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00926600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: