Individual
MRS. AMANDA MOORE CHASTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
2035 REGENCY RD, SUITE 5, LEXINGTON, KY 40503-2333
(859) 402-1553
(859) 402-1553
Mailing address
2035 REGENCY RD, SUITE 5, LEXINGTON, KY 40503-2333
(859) 402-1553
(859) 402-1553
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3648
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000648031
ANTHEM
KY
05
—
7100286880
—
KY
Enumeration date
08/11/2009
Last updated
08/07/2014
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