Provider Demographics
NPI:1053577346
Name:CHAISSON, AMY R (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:CHAISSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CUSABO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-3209
Mailing Address - Country:US
Mailing Address - Phone:843-473-5423
Mailing Address - Fax:
Practice Address - Street 1:800 FORDING ISLAND RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4845
Practice Address - Country:US
Practice Address - Phone:843-553-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist