Provider Demographics
NPI:1851085435
Name:SMITH, CHELSEA CATHERINE CHIMBLO (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:CATHERINE CHIMBLO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:CHELSEA
Other - Middle Name:CATHERINE
Other - Last Name:CHIMVLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3445 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9067
Mailing Address - Country:US
Mailing Address - Phone:203-571-7393
Mailing Address - Fax:
Practice Address - Street 1:9579 VOCATIONAL DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9043
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist