Provider Demographics
NPI:1518574516
Name:ASBURY, CHELSEY MARIE (MED)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:MARIE
Last Name:ASBURY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:MARIE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2040 SUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-352-8791
Mailing Address - Fax:
Practice Address - Street 1:2040 SUTLER AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-352-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
384-140103K00000X
WI384-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst