Provider Demographics
NPI:1619485471
Name:SUMMERS, CHELSEY NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:NICOLE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N RAINBOW BLVD APT 1071
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4542
Mailing Address - Country:US
Mailing Address - Phone:972-658-8862
Mailing Address - Fax:
Practice Address - Street 1:1333 N BUFFALO DR UNIT 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3637
Practice Address - Country:US
Practice Address - Phone:702-979-4268
Practice Address - Fax:702-979-1336
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112119235Z00000X
NVSP-2259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist