Provider Demographics
NPI:1407366578
Name:LONG, CHELSEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MA, 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:HC 1 BOX 76C
Mailing Address - Street 2:
Mailing Address - City:LEOPOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63760-9753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:481 N BEDFORD ST
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-9144
Practice Address - Country:US
Practice Address - Phone:573-222-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist