Provider Demographics
NPI:1902076243
Name:CHAPMAN, JOHANNA ELLEN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:ELLEN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GLENHAWK LOOP
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8420
Mailing Address - Country:US
Mailing Address - Phone:803-917-9471
Mailing Address - Fax:
Practice Address - Street 1:13 GLENHAWK LOOP
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8420
Practice Address - Country:US
Practice Address - Phone:803-917-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist