Provider Demographics
NPI:1962782045
Name:UDE, CHANDLER B (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHANDLER
Middle Name:B
Last Name:UDE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6239
Mailing Address - Country:US
Mailing Address - Phone:469-222-1335
Mailing Address - Fax:
Practice Address - Street 1:508 GILBERT RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6239
Practice Address - Country:US
Practice Address - Phone:469-222-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist