Individual
CHRIS VANDIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 CHERRYWOOD PL, JACKSON, TN 38305-1741
(731) 664-0915
Mailing address
100 CHERRYWOOD PL, JACKSON, TN 38305-1741
(731) 664-0915
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000002092
TN
Other
Enumeration date
01/04/2009
Last updated
01/04/2009
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