MEDICARE: CHANTELLE BALLARD VARNADO SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202006179	VA
2	235Z00000X	Speech-Language Pathologist	4777	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154622868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTELLE BALLARD VARNADO SLP

Provider Business Mailing Address
First Line	:	2211 AUGUSTA LN
Second Line	:	LAUNCH
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4933
Country	:	US
Telephone Number	:	225-238-1741
Fax Number	:	225-341-8749

Provider Business Practice Location Address
First Line	:	2211 AUGUSTA LN
Second Line	:	LAUNCH
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4933
Country	:	US
Telephone Number	:	225-238-1741
Fax Number	:	225-341-8749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	06/18/2015

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