Provider Demographics
NPI:1932587789
Name:CHANDLER, STEPHANIE GREGG (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:GREGG
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:GREGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:3615 BRASELTON HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5907
Mailing Address - Country:US
Mailing Address - Phone:678-377-9634
Mailing Address - Fax:678-377-9609
Practice Address - Street 1:3615 BRASELTON HWY STE 103
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5907
Practice Address - Country:US
Practice Address - Phone:678-377-9634
Practice Address - Fax:678-377-9609
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist