Provider Demographics
NPI:1093818908
Name:HNATH-CHISOLM, THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:HNATH-CHISOLM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:CHISOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2906 W BAY VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1606
Mailing Address - Country:US
Mailing Address - Phone:813-974-9826
Mailing Address - Fax:813-974-0822
Practice Address - Street 1:4202 E FOWLER AVEUNE
Practice Address - Street 2:UNIVERSITY OF SOUTH FLORIDA PCD 1017
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620
Practice Address - Country:US
Practice Address - Phone:813-974-9826
Practice Address - Fax:813-974-0822
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY149231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist