Provider Demographics
NPI:1659743839
Name:PENCARINHA, CHELSEA (ST)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PENCARINHA
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:199 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72153-7566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:AR
Practice Address - Zip Code:72153-7566
Practice Address - Country:US
Practice Address - Phone:501-723-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant