Provider Demographics
NPI:1649709957
Name:MATTEA, CHELSEA LEIGH (MA-CCC SLP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEIGH
Last Name:MATTEA
Suffix:
Gender:F
Credentials:MA-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3728
Mailing Address - Country:US
Mailing Address - Phone:618-344-8476
Mailing Address - Fax:
Practice Address - Street 1:614 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3728
Practice Address - Country:US
Practice Address - Phone:618-344-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist