Provider Demographics
NPI:1902191422
Name:LACELLE, CHANTALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHANTALE
Middle Name:
Last Name:LACELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD RM G4.212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8886
Mailing Address - Country:US
Mailing Address - Phone:214-648-3450
Mailing Address - Fax:214-648-9131
Practice Address - Street 1:5323 HARRY HINES BLVD RM G4.212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8886
Practice Address - Country:US
Practice Address - Phone:214-648-3450
Practice Address - Fax:214-648-9131
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician