Provider Demographics
NPI:1477868479
Name:CHASE, SHARON BRADY (MC,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:BRADY
Last Name:CHASE
Suffix:
Gender:F
Credentials:MC,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1508
Mailing Address - Country:US
Mailing Address - Phone:570-457-4450
Mailing Address - Fax:570-457-4450
Practice Address - Street 1:108 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1508
Practice Address - Country:US
Practice Address - Phone:570-457-4450
Practice Address - Fax:570-457-4450
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL 004431L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist