Provider Demographics
NPI:1629269303
Name:ANTONAK, CHRIS C (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRIS
Middle Name:C
Last Name:ANTONAK
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 1:6 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1034
Mailing Address - Country:US
Mailing Address - Phone:508-528-1680
Mailing Address - Fax:
Practice Address - Street 1:130 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3903
Practice Address - Country:US
Practice Address - Phone:508-528-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist