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General NPI Number Information
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NPI Number | 1205158458
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Entity Type | Individual
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Provider Name | MANDI R CHAMBLESS AU.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 1530 SUN CITY BLVD STE 140
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City | GEORGETOWN
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State | TX
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Zip | 78633-5351
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Country | US
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Telephone | 512-868-3109
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 HICKORY RIDGE CV
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City | ROUND ROCK
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State | TX
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Zip | 78665-7802
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Country | US
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Telephone | 512-705-8827
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 51765
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License Number State | TX
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