Provider Demographics
NPI:1275702052
Name:CHAMBERLAIN, ADRIANA (SLP)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3506
Mailing Address - Country:US
Mailing Address - Phone:203-384-8681
Mailing Address - Fax:203-389-4072
Practice Address - Street 1:2900 MAIN ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4946
Practice Address - Country:US
Practice Address - Phone:203-378-0092
Practice Address - Fax:203-375-4540
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist