Provider Demographics
NPI:1194291781
Name:CHACE, ALEXANDRIA (MSED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:CHACE
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 STATE HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-3747
Mailing Address - Country:US
Mailing Address - Phone:518-775-5760
Mailing Address - Fax:
Practice Address - Street 1:234 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1935
Practice Address - Country:US
Practice Address - Phone:518-775-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist