Provider Demographics
NPI:1063670909
Name:CHANDONAIS, BETHANY NICOLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:NICOLE
Last Name:CHANDONAIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43521 KIPLINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3602
Mailing Address - Country:US
Mailing Address - Phone:586-404-6284
Mailing Address - Fax:
Practice Address - Street 1:43521 KIPLINGTON SQ
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-3602
Practice Address - Country:US
Practice Address - Phone:586-404-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist