Provider Demographics
NPI:1922415876
Name:BRUINSMA, CHELSEA DIANE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:DIANE
Last Name:BRUINSMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:CHELSEA
Other - Middle Name:DIANE
Other - Last Name:BLACKMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11877 RITCHIE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-9400
Mailing Address - Country:US
Mailing Address - Phone:616-560-2987
Mailing Address - Fax:
Practice Address - Street 1:1305 WALKER AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4098
Practice Address - Country:US
Practice Address - Phone:616-419-3095
Practice Address - Fax:616-419-3147
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program