Provider Demographics
NPI:1174367601
Name:CHANEY, MICHALA ALEXANDRA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHALA
Middle Name:ALEXANDRA
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9778
Mailing Address - Country:US
Mailing Address - Phone:937-779-7977
Mailing Address - Fax:
Practice Address - Street 1:299 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-7516
Practice Address - Country:US
Practice Address - Phone:937-396-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15144235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist