Provider Demographics
NPI:1629320957
Name:FIFTH CHIP, INC
Entity Type:Organization
Organization Name:FIFTH CHIP, INC
Other - Org Name:CHIPPENDALE AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CHIPPENDALE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, FAAA
Authorized Official - Phone:239-772-0940
Mailing Address - Street 1:6215 BROOKSHIRE TER
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4239
Mailing Address - Country:US
Mailing Address - Phone:239-994-8322
Mailing Address - Fax:
Practice Address - Street 1:1224 DEL PRADO BLVD S
Practice Address - Street 2:SUITE C
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3670
Practice Address - Country:US
Practice Address - Phone:239-772-0940
Practice Address - Fax:239-677-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY302231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty