Provider Demographics
NPI:1467175836
Name:CHANDLER, KRISTINE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:CHANDLER
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ND
Mailing Address - Zip Code:58274-0308
Mailing Address - Country:US
Mailing Address - Phone:701-788-2004
Mailing Address - Fax:
Practice Address - Street 1:600 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ND
Practice Address - Zip Code:58274-4032
Practice Address - Country:US
Practice Address - Phone:701-788-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist