Provider Demographics
NPI:1962116582
Name:CHESTNA, PHOEBE L (SLP)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:L
Last Name:CHESTNA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358096
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-5096
Mailing Address - Country:US
Mailing Address - Phone:203-998-6678
Mailing Address - Fax:203-987-3099
Practice Address - Street 1:910 BOSTON TPKE STE 3
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3396
Practice Address - Country:US
Practice Address - Phone:203-998-6678
Practice Address - Fax:203-987-3099
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist