Provider Demographics
NPI:1851030456
Name:GRAYBEAL, CHANDLER (MS)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-9435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:337-660-2241
Practice Address - Street 1:3913 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-9435
Practice Address - Country:US
Practice Address - Phone:337-201-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9068OtherLBESPA