Provider Demographics
NPI:1164247268
Name:HARRISON, CHANTRES AUSTIN (M A CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHANTRES
Middle Name:AUSTIN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 STONE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-1943
Mailing Address - Country:US
Mailing Address - Phone:704-450-9809
Mailing Address - Fax:
Practice Address - Street 1:2001 VAN HAVEN DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4342
Practice Address - Country:US
Practice Address - Phone:704-883-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist