Provider Demographics
NPI:1396378659
Name:LAYNE, CHESNEE
Entity Type:Individual
Prefix:
First Name:CHESNEE
Middle Name:
Last Name:LAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19677 STATE ROAD 71 N
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-6613
Mailing Address - Country:US
Mailing Address - Phone:850-545-0248
Mailing Address - Fax:
Practice Address - Street 1:19677 STATE ROAD 71 N
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-6613
Practice Address - Country:US
Practice Address - Phone:850-545-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency