Provider Demographics
NPI:1851949622
Name:HODGKIN, CHANDLER MARIE (MA, SLP)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:MARIE
Last Name:HODGKIN
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E WILLIAM ST APT 25D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2428
Mailing Address - Country:US
Mailing Address - Phone:810-569-0672
Mailing Address - Fax:
Practice Address - Street 1:12575 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4019
Practice Address - Country:US
Practice Address - Phone:734-287-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist