Basic Information
| Provider Information | |||||||||
| NPI: | 1720673825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASKIN | ||||||||
| FirstName: | CHANDLER | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 168 | ||||||||
| Address2: | |||||||||
| City: | CRYSTAL SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390590168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505889641 | ||||||||
| FaxNumber: | 8887110441 | ||||||||
| Practice Location | |||||||||
| Address1: | 4015 2ND AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294867882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039297408 | ||||||||
| FaxNumber: | 8887110441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2021 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7011 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 7011 | 01 | SC | SPEECH-LANGUAGE PATHOLOGIST | OTHER |