Provider Demographics
NPI:1720673825
Name:HITES, CHANDLER WASKIN
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:WASKIN
Last Name:HITES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3007
Mailing Address - Country:US
Mailing Address - Phone:724-944-4891
Mailing Address - Fax:
Practice Address - Street 1:211 CORONADO RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3007
Practice Address - Country:US
Practice Address - Phone:724-944-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7011OtherSPEECH-LANGUAGE PATHOLOGIST