Provider Demographics
NPI:1285069492
Name:WELLS, CHANDRA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BETWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1202
Mailing Address - Country:US
Mailing Address - Phone:518-417-1786
Mailing Address - Fax:518-708-6961
Practice Address - Street 1:33 BETWOOD ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209
Practice Address - Country:US
Practice Address - Phone:518-417-1786
Practice Address - Fax:518-708-6961
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist