Provider Demographics
NPI:1821147968
Name:CHATMAN, KANDIS HARRIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KANDIS
Middle Name:HARRIS
Last Name:CHATMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KANDIS
Other - Middle Name:LORETTA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:BOX 870242
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0001
Mailing Address - Country:US
Mailing Address - Phone:205-348-7131
Mailing Address - Fax:205-348-1845
Practice Address - Street 1:700 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-348-7131
Practice Address - Fax:205-348-1845
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528857OtherBLUE CROSS BLUE SHEILD
AL890013630Medicaid