Provider Demographics
NPI:1538533922
Name:CLEMENTS, CHELSEA (MS CFY-SLP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 N 42ND RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IL
Mailing Address - Zip Code:60551-9682
Mailing Address - Country:US
Mailing Address - Phone:815-901-2172
Mailing Address - Fax:
Practice Address - Street 1:1918 W MELROSE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2033
Practice Address - Country:US
Practice Address - Phone:312-600-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist