Provider Demographics
NPI:1821634353
Name:CHACON, KARLA MARIA (SLP)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIA
Last Name:CHACON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 W WHITEHALL RD APT 4
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2903
Mailing Address - Country:US
Mailing Address - Phone:305-915-7581
Mailing Address - Fax:
Practice Address - Street 1:901 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4025
Practice Address - Country:US
Practice Address - Phone:814-944-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist