Healthcare Provider Details

I. General information

NPI: 1770036428
Provider Name (Legal Business Name): CHELSEA M. JIVIDEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 INWOOD RD.
DALLAS TX
75235
US

IV. Provider business mailing address

1966 INWOOD RD.
DALLAS TX
75235
US

V. Phone/Fax

Practice location:
  • Phone: 214-905-3000
  • Fax: 214-905-3022
Mailing address:
  • Phone: 214-905-3000
  • Fax: 214-905-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: