Healthcare Provider Details

I. General information

NPI: 1073598504
Provider Name (Legal Business Name): JENNIFER KRISTINE CHACON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 US 29 BUS
DANVILLE VA
24540
US

IV. Provider business mailing address

1180 DAVID GILES LN
BLAIRS VA
24527-3768
US

V. Phone/Fax

Practice location:
  • Phone: 434-661-5352
  • Fax: 434-302-9988
Mailing address:
  • Phone: 434-661-5352
  • Fax: 434-302-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010813
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: