Provider Demographics
NPI:1457574691
Name:CHANDLER, CHARLOTTE CONNARD (MA CCSLP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CONNARD
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MA CCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 COUNTRY MDW
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5887
Mailing Address - Country:US
Mailing Address - Phone:830-336-2000
Mailing Address - Fax:
Practice Address - Street 1:15316 HUEBNER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0987
Practice Address - Country:US
Practice Address - Phone:210-614-4567
Practice Address - Fax:210-614-4999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3389OtherBCBS PROVIDER