Channing Heavenor Creveling, MA CCC-SLP LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA12781 Issued in FL

Practice address

2400 S Highway 27 Ste B201
Clermont, FL 34711-6816

Phone

(352) 394-0212

Fax

(352) 241-6361

NPI assigned

Jul 19, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Ms. Channing Heavenor Creveling Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602288000000",
    "number": "1700805686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 E SILVER STAR RD STE 133",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347617014",
            "telephone_number": "910-538-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 S HIGHWAY 27 STE B201",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116816",
            "telephone_number": "352-394-0212",
            "fax_number": "352-241-6361"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5125 Adanson St Ste 750",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328041327",
            "country_code": "US",
            "telephone_number": "352-394-0212",
            "fax_number": "352-241-6361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CREVELING",
        "first_name": "CHANNING",
        "middle_name": "HEAVENOR",
        "name_prefix": "Ms.",
        "credential": "MA CCC-SLP LLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-10-10",
        "certification_date": "2020-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA12781",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "6881",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7412500",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104167600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANNING",
            "last_name": "CREVELING",
            "middle_name": "HEAVENOR",
            "prefix": "MS.",
            "credential": "MA CCC SLP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Speech-Language Pathologist in Clermont, FL
• Providers in Clermont, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.