Provider Demographics
NPI:1205158458
Name:CHAMBLESS, MANDI R (AUD)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:R
Last Name:CHAMBLESS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 HICKORY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7802
Mailing Address - Country:US
Mailing Address - Phone:512-705-8827
Mailing Address - Fax:
Practice Address - Street 1:1530 SUN CITY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5351
Practice Address - Country:US
Practice Address - Phone:512-868-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51765237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter