1033341961 NPI number — MRS. AMANDA MOORE CHASTAIN M.A., CCC-SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033341961 NPI number — MRS. AMANDA MOORE CHASTAIN M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHASTAIN
Provider First Name:
AMANDA
Provider Middle Name:
MOORE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033341961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2035 REGENCY RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-402-1553
Provider Business Mailing Address Fax Number:
859-402-1553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2035 REGENCY RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-402-1553
Provider Business Practice Location Address Fax Number:
859-402-1553
Provider Enumeration Date:
08/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3648 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100286880 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000648031 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com