Provider Demographics
NPI:1336620624
Name:BUNNELL, CHELSEA KM (LSW)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KM
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BIEDE AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2497
Mailing Address - Country:US
Mailing Address - Phone:419-782-8856
Mailing Address - Fax:419-784-4506
Practice Address - Street 1:910 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1841
Practice Address - Country:US
Practice Address - Phone:419-636-2932
Practice Address - Fax:419-636-1982
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker