Provider Demographics
NPI:1861933608
Name:PONTIUS, CHESTER
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2532
Mailing Address - Country:US
Mailing Address - Phone:816-676-2900
Mailing Address - Fax:816-676-2901
Practice Address - Street 1:1105 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2532
Practice Address - Country:US
Practice Address - Phone:816-676-2900
Practice Address - Fax:816-676-2901
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005828237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist