Provider Demographics
NPI:1033406822
Name:CHAMBERLIN, LOUISE KAY (MS, CCC-SLP, ATP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:KAY
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4336
Mailing Address - Country:US
Mailing Address - Phone:951-834-3365
Mailing Address - Fax:
Practice Address - Street 1:1731 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3026
Practice Address - Country:US
Practice Address - Phone:202-981-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008836235Z00000X
CASP 19034235Z00000X
DCSLP001229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHJ785ZMedicare PIN