Provider Demographics
NPI:1447600960
Name:ANDERSON, CHELSEY
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CAMINO DEL RIO S
Mailing Address - Street 2:#308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3821
Mailing Address - Country:US
Mailing Address - Phone:619-546-0039
Mailing Address - Fax:619-546-0037
Practice Address - Street 1:2820 CAMINO DEL RIO S
Practice Address - Street 2:#308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3821
Practice Address - Country:US
Practice Address - Phone:619-546-0039
Practice Address - Fax:619-546-0037
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-5107709OtherTAX ID