Provider Demographics
NPI:1356413124
Name:CHAMBERLAIN, KRISTI (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 DUFF DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2818
Mailing Address - Country:US
Mailing Address - Phone:256-874-1657
Mailing Address - Fax:
Practice Address - Street 1:732 THIMBLE SHOALS BLVD STE 905
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-867-9424
Practice Address - Fax:757-867-9416
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist