Provider Demographics
NPI:1326163023
Name:CHAMBERLAIN, CHRISTINE JEANNETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JEANNETTE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:JEANNETTE
Other - Last Name:BEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:639 W. CHESTNUT EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802
Mailing Address - Country:US
Mailing Address - Phone:417-523-0000
Mailing Address - Fax:417-523-0196
Practice Address - Street 1:639 W. CHESTNUT EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-523-7500
Practice Address - Fax:417-523-0196
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015814235Z00000X
MO2007019175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO469893309Medicaid