Provider Demographics
NPI:1013270701
Name:CHAPPELL., AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CHAPPELL.
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CLUB CENTRE CT
Mailing Address - Street 2:APT 3
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3520
Mailing Address - Country:US
Mailing Address - Phone:618-917-0867
Mailing Address - Fax:
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:618-632-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist