Healthcare Provider Details

I. General information

NPI: 1740714468
Provider Name (Legal Business Name): JENNY LYNN CHAUMP RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 BEE ST SUITE 201 CHARLESTON
CHARLESTON SC
29425-8912
US

IV. Provider business mailing address

1529 GRAND AVE
ASTORIA OR
97103-3719
US

V. Phone/Fax

Practice location:
  • Phone: 570-954-3464
  • Fax:
Mailing address:
  • Phone: 570-954-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number153682
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: