Provider Demographics
NPI:1790124600
Name:SMITH, CHELSEY MORRIS (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:MORRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 TRIBBLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3451
Mailing Address - Country:US
Mailing Address - Phone:205-821-9519
Mailing Address - Fax:
Practice Address - Street 1:1805 TRIBBLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3451
Practice Address - Country:US
Practice Address - Phone:205-821-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist