Provider Demographics
NPI:1164899076
Name:PROSE, JOANNA CHANLETT (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:CHANLETT
Last Name:PROSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:PROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 CEDAR HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1628
Mailing Address - Country:US
Mailing Address - Phone:984-330-4377
Mailing Address - Fax:
Practice Address - Street 1:4328 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5272
Practice Address - Country:US
Practice Address - Phone:919-824-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008738235Z00000X
NC11611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist