Provider Demographics
NPI:1235882390
Name:CHANDLER, CHRISTA BREN (BBA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:BREN
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:BBA
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17167
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7167
Mailing Address - Country:US
Mailing Address - Phone:601-261-5995
Mailing Address - Fax:601-261-5335
Practice Address - Street 1:1417 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4024
Practice Address - Country:US
Practice Address - Phone:601-693-6626
Practice Address - Fax:601-693-6676
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA702237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist