Provider Demographics
NPI:1669636916
Name:CHARTIER, MARI LEE (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:MARI LEE
Middle Name:
Last Name:CHARTIER
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 1:3705 MEDICAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1027
Mailing Address - Country:US
Mailing Address - Phone:512-324-2720
Mailing Address - Fax:512-324-2724
Practice Address - Street 1:3705 MEDICAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1027
Practice Address - Country:US
Practice Address - Phone:512-324-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51012231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L9808Medicare PIN