Basic Information
Provider Information
NPI: 1689800765
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: CHRISHAUN
MiddleName: MOUZON
NamePrefix:  
NameSuffix:  
Credential: MA SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MOUZON
OtherFirstName: CHRISHAUN
OtherMiddleName: T
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MA SLP
OtherLastNameType: 1
Mailing Information
Address1: 2222 SULLIVAN TRL
Address2:  
City: EASTON
State: PA
PostalCode: 180407958
CountryCode: US
TelephoneNumber: 8009449782
FaxNumber: 6104382024
Practice Location
Address1: 1830 W MAIN ST
Address2:  
City: ROCK HILL
State: SC
PostalCode: 297328965
CountryCode: US
TelephoneNumber: 8039804100
FaxNumber: 8039804218
Other Information
ProviderEnumerationDate: 06/03/2009
LastUpdateDate: 06/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X2849SCY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home