Provider Demographics
NPI:1053686436
Name:CHANDLER, KATIE RAE (TSHH)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:RAE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ROBERT QUIGLEY DR
Mailing Address - Street 2:APT. 1
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-1040
Mailing Address - Country:US
Mailing Address - Phone:607-972-7308
Mailing Address - Fax:
Practice Address - Street 1:543 ROBERT QUIGLEY DR
Practice Address - Street 2:APT. 1
Practice Address - City:SCOTTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14546-1040
Practice Address - Country:US
Practice Address - Phone:607-972-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1421026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist