Provider Demographics
NPI:1073734992
Name:CHAMBERS, TESSA MARY (SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:MARY
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525
Mailing Address - Country:US
Mailing Address - Phone:304-379-4045
Mailing Address - Fax:
Practice Address - Street 1:80 OLD NEW SALEM RD
Practice Address - Street 2:ARC FAYETTE
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-438-8416
Practice Address - Fax:724-438-2405
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004619L235Z00000X
WVSLP1010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0153478000Medicaid
WV0153478000Medicaid