Provider Demographics
NPI:1972909851
Name:WALL, CHELSIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHELSIE
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:CHELSIE
Other - Middle Name:
Other - Last Name:DAHLQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 N GLEASON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-6149
Mailing Address - Country:US
Mailing Address - Phone:620-621-2385
Mailing Address - Fax:
Practice Address - Street 1:1705 N GLEASON AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-6149
Practice Address - Country:US
Practice Address - Phone:620-621-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist