Provider Demographics
NPI:1467938605
Name:GAY, CHELCI JO (DR)
Entity Type:Individual
Prefix:
First Name:CHELCI
Middle Name:JO
Last Name:GAY
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:CHELCI
Other - Middle Name:
Other - Last Name:BORLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2069 SHELA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5782
Mailing Address - Country:US
Mailing Address - Phone:740-851-2923
Mailing Address - Fax:
Practice Address - Street 1:2530 WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7528
Practice Address - Country:US
Practice Address - Phone:740-851-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246086231H00000X
OHA.02161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty