Provider Demographics
NPI:1225060163
Name:CHASE, PATRICIA A (PHD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:CHASE
Suffix:
Gender:F
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70403
Mailing Address - Street 2:807 UNIVERSITY PKWY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4071
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:807 UNIVERSITY PKWY
Practice Address - Street 2:LAMB HALL ROOM 361
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6500
Practice Address - Country:US
Practice Address - Phone:423-439-4584
Practice Address - Fax:423-439-4607
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001255231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510975Medicaid
TN4059318OtherBCBST
3198225Medicare PIN
3198225Medicare Oscar/Certification