Provider Demographics
NPI:1366689010
Name:CHAET, NAN MICHELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:MICHELE
Last Name:CHAET
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3230
Mailing Address - Country:US
Mailing Address - Phone:805-648-1015
Mailing Address - Fax:
Practice Address - Street 1:36 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3230
Practice Address - Country:US
Practice Address - Phone:805-648-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist