Provider Demographics
NPI:1801336805
Name:PANTLE, CHELSIE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:PANTLE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RANKIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ENCAMPMENT
Mailing Address - State:WY
Mailing Address - Zip Code:82325-0604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 W. SPRING STREET
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-1481
Practice Address - Country:US
Practice Address - Phone:307-326-5839
Practice Address - Fax:307-326-5879
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP/CFY-880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist