Provider Demographics
NPI:1336353549
Name:ABBOTT, CHANDA JO (AUD)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:JO
Last Name:ABBOTT
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 1:17099 TEXAS AVE
Mailing Address - Street 2:#200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4069
Mailing Address - Country:US
Mailing Address - Phone:281-332-4575
Mailing Address - Fax:281-554-4722
Practice Address - Street 1:17099 TEXAS AVE
Practice Address - Street 2:#200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4069
Practice Address - Country:US
Practice Address - Phone:281-332-4575
Practice Address - Fax:281-554-4722
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51441231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist