Provider Demographics
NPI:1275258410
Name:BARNEY, CHANDRA (SLPA)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:BARNEY
Suffix:
Gender:F
Credentials:SLPA
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 4744
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4744
Mailing Address - Country:US
Mailing Address - Phone:208-721-2498
Mailing Address - Fax:
Practice Address - Street 1:344 N 15TH AVE APT 10H
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4069
Practice Address - Country:US
Practice Address - Phone:208-721-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLPA-54942355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant