Basic Information
Provider Information
NPI: 1003141037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEST CHESNUT
FirstName: STEPHANIE
MiddleName: GAIL
NamePrefix: MS.
NameSuffix:  
Credential: AUD.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber: 2146458898
FaxNumber: 2146458894
Practice Location
Address1: 5323 HARRY HINES BOULEVARD
Address2:  
City: DALLAS
State: TX
PostalCode: 753907208
CountryCode: US
TelephoneNumber: 2146458898
FaxNumber: 2146458894
Other Information
ProviderEnumerationDate: 10/08/2009
LastUpdateDate: 03/27/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X80512TXY Speech, Language and Hearing Service ProvidersAudiologist 
231H00000X924MAN Speech, Language and Hearing Service ProvidersAudiologist 
237600000X924MAN Speech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter 

No ID Information.


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