Provider Demographics
NPI:1992324677
Name:CHANCE, DARTHA KATHRYN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DARTHA
Middle Name:KATHRYN
Last Name:CHANCE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4269
Mailing Address - Country:US
Mailing Address - Phone:404-543-9729
Mailing Address - Fax:
Practice Address - Street 1:107 BAINBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4269
Practice Address - Country:US
Practice Address - Phone:404-543-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP6005573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist