Provider Demographics
NPI:1467428110
Name:CHASTAIN-MCDOWELL, KELLY LYNN (MA CCC A)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:CHASTAIN-MCDOWELL
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 MITCHELL RD STE B
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-5558
Mailing Address - Country:US
Mailing Address - Phone:812-275-4479
Mailing Address - Fax:812-275-4495
Practice Address - Street 1:3525 MITCHELL RD STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5558
Practice Address - Country:US
Practice Address - Phone:812-275-4479
Practice Address - Fax:812-275-4495
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002103A237600000X
231H00000X, 231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200028290Medicaid
IN145040AMedicare ID - Type Unspecified