Provider Demographics
NPI:1346579513
Name:WILLIAMS, CHANDRA
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1031 AVENIDA PICO STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6356
Mailing Address - Country:US
Mailing Address - Phone:949-388-8788
Mailing Address - Fax:949-388-0829
Practice Address - Street 1:1031 AVENIDA PICO STE 201
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6356
Practice Address - Country:US
Practice Address - Phone:949-388-8788
Practice Address - Fax:949-388-0829
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist