Provider Demographics
NPI:1760178396
Name:BODE, CHELSEA GRANT (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:GRANT
Last Name:BODE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:CHELSEA
Other - Middle Name:BROOKE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 WALKERS POND DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4974
Mailing Address - Country:US
Mailing Address - Phone:678-490-1291
Mailing Address - Fax:
Practice Address - Street 1:2323 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4506
Practice Address - Country:US
Practice Address - Phone:770-927-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist