Provider Demographics
NPI:1689400244
Name:CHAMBERS, CORTNEY ELYSE
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:ELYSE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7461 UPPER ROY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHORE
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2409
Mailing Address - Country:US
Mailing Address - Phone:218-838-3903
Mailing Address - Fax:
Practice Address - Street 1:7461 UPPER ROY LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE SHORE
Practice Address - State:MN
Practice Address - Zip Code:56468-2409
Practice Address - Country:US
Practice Address - Phone:218-838-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist