Individual
JEREMY DANIEL CHATTERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
3483 E 3195 N, KIMBERLY, ID 83341-5353
(208) 751-5308
Mailing address
3483 E 3195 N, KIMBERLY, ID 83341-5353
(208) 751-5308
(208) 544-4281
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-3273
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP-3572
DIVISION OF OCCUPATION AND PROFESSIONAL LICENSES
ID
01
—
TSLP-3273
PROVISIONAL LICENSE
ID
Enumeration date
08/22/2017
Last updated
05/19/2023
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