Provider Demographics
NPI:1174401533
Name:CHESTNUT, CHAVANNAH COE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHAVANNAH
Middle Name:COE
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 CREEK VALE WAY APT 1A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9461
Mailing Address - Country:US
Mailing Address - Phone:812-698-0135
Mailing Address - Fax:
Practice Address - Street 1:4135 W SMITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9006
Practice Address - Country:US
Practice Address - Phone:317-885-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004558A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist