Provider Demographics
NPI:1487991154
Name:CHESTER, SHANTA LATRICE
Entity type:Individual
Prefix:
First Name:SHANTA
Middle Name:LATRICE
Last Name:CHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANTA
Other - Middle Name:LATRICE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 N DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-1437
Mailing Address - Country:US
Mailing Address - Phone:803-484-9475
Mailing Address - Fax:
Practice Address - Street 1:603 N DENNIS AVE
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1437
Practice Address - Country:US
Practice Address - Phone:803-484-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant