Provider Demographics
NPI:1740224161
Name:CHASE, KATHY C (CCC-A)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:C
Last Name:CHASE
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:K
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1761 W M43 HWY
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058
Mailing Address - Country:US
Mailing Address - Phone:269-945-2030
Mailing Address - Fax:269-945-2115
Practice Address - Street 1:1761 W M43 HWY
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058
Practice Address - Country:US
Practice Address - Phone:269-945-2030
Practice Address - Fax:269-945-2115
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50624231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI865186836Medicaid
MI865186836Medicaid