Provider Demographics
NPI:1417617317
Name:GRACE, CHANDLER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TRIPLETT ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3564
Mailing Address - Country:US
Mailing Address - Phone:270-683-4517
Mailing Address - Fax:270-852-1491
Practice Address - Street 1:815 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3564
Practice Address - Country:US
Practice Address - Phone:270-683-4517
Practice Address - Fax:270-852-1491
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY274670OtherSTATE LICENSE