Provider Demographics
NPI:1225387228
Name:CHANDLER, TERRYL CHRISTINA
Entity type:Individual
Prefix:
First Name:TERRYL
Middle Name:CHRISTINA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 0AK BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736
Mailing Address - Country:US
Mailing Address - Phone:074-953-7457
Mailing Address - Fax:
Practice Address - Street 1:3173 0AK BROOK LANE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736
Practice Address - Country:US
Practice Address - Phone:074-953-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist