Provider Demographics
NPI:1538381959
Name:CHAMBERLIN, AUDREY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:LYNN
Other - Last Name:CATHCART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:8508 TIDEWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8916
Mailing Address - Country:US
Mailing Address - Phone:317-332-4158
Mailing Address - Fax:317-823-5718
Practice Address - Street 1:8508 TIDEWATER DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8916
Practice Address - Country:US
Practice Address - Phone:317-332-4158
Practice Address - Fax:317-823-5718
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002080A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist