Provider Demographics
NPI:1174187041
Name:WURDEMAN, CHELSEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:WURDEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
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 274
Mailing Address - Street 2:
Mailing Address - City:PLATTE CENTER
Mailing Address - State:NE
Mailing Address - Zip Code:68653-0274
Mailing Address - Country:US
Mailing Address - Phone:402-942-1453
Mailing Address - Fax:
Practice Address - Street 1:2855 40TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2152
Practice Address - Country:US
Practice Address - Phone:402-564-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist