Provider Demographics
NPI:1982804381
Name:CHANCEY, INA MARIE (MS/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:INA
Middle Name:MARIE
Last Name:CHANCEY
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8649 REGENCY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5742
Mailing Address - Country:US
Mailing Address - Phone:727-843-4035
Mailing Address - Fax:727-817-0475
Practice Address - Street 1:8649 REGENCY PARK BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-5742
Practice Address - Country:US
Practice Address - Phone:727-843-4035
Practice Address - Fax:727-817-0475
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SA 1638OtherSPEECH PATHOLOGIST