Provider Demographics
NPI:1568953701
Name:TOTH, CHANTELLE M (SLP)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:M
Last Name:TOTH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9651 MAPLE TREE RD
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9744
Mailing Address - Country:US
Mailing Address - Phone:262-305-6744
Mailing Address - Fax:
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6505
Practice Address - Country:US
Practice Address - Phone:262-293-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist