Provider Demographics
NPI:1538692827
Name:WADIAK, CHELSEA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:WADIAK
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 1:18220 N 68TH ST
Mailing Address - Street 2:APT. #330
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-9201
Mailing Address - Country:US
Mailing Address - Phone:732-476-8931
Mailing Address - Fax:
Practice Address - Street 1:18220 N 68TH ST
Practice Address - Street 2:APT. #330
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-9201
Practice Address - Country:US
Practice Address - Phone:732-476-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist