Provider Demographics
NPI:1124342365
Name:CHASE, WENDY MARSHALL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MARSHALL
Last Name:CHASE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BOLTON RD UNIT 1085
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1085
Mailing Address - Country:US
Mailing Address - Phone:860-486-3265
Mailing Address - Fax:860-486-4948
Practice Address - Street 1:850 BOLTON RD UNIT 1085
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-1085
Practice Address - Country:US
Practice Address - Phone:860-486-3265
Practice Address - Fax:860-486-4948
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1124342365Medicaid
CT1124342365Medicaid