Healthcare Provider Details

I. General information

NPI: 1275894081
Provider Name (Legal Business Name): MARY E CHAMBERS M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BOGARDUS RD
ALBANY NY
12208-1825
US

IV. Provider business mailing address

18 BOGARDUS RD
ALBANY NY
12208-1825
US

V. Phone/Fax

Practice location:
  • Phone: 845-750-4510
  • Fax:
Mailing address:
  • Phone: 845-750-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number022698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: