Provider Demographics
NPI:1881286805
Name:TUMBARELLO, CHELSEA NICOLE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICOLE
Last Name:TUMBARELLO
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 1:3990 ABBEY LN # B302
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2237
Mailing Address - Country:US
Mailing Address - Phone:503-298-3614
Mailing Address - Fax:
Practice Address - Street 1:785 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5947
Practice Address - Country:US
Practice Address - Phone:503-325-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist