Provider Demographics
NPI:1881028025
Name:CHASTAIN, PATRICIA DUBOSE (MA SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DUBOSE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:MA SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GRIFFIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-6929
Mailing Address - Country:US
Mailing Address - Phone:864-397-1048
Mailing Address - Fax:864-855-8159
Practice Address - Street 1:1400 GRIFFIN MILL RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-6929
Practice Address - Country:US
Practice Address - Phone:864-397-1048
Practice Address - Fax:864-855-8159
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist