MEDICARE: CHELSEA MEYER DEITERS M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2003027446	MO

General Provider Information

NPI Number	:	1285774802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA MEYER DEITERS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	141 N MERAMEC AVE
Second Line	:	STE 110A
City	:	CLAYTON
State	:	MO
Zip	:	63105-3750
Country	:	US
Telephone Number	:	314-704-5727
Fax Number	:	314-863-7545

Provider Business Practice Location Address
First Line	:	141 N MERAMEC AVE
Second Line	:	STE 110A
City	:	CLAYTON
State	:	MO
Zip	:	63105-3750
Country	:	US
Telephone Number	:	314-704-5727
Fax Number	:	314-863-7545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/28/2008

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Directions to “ CHELSEA MEYER DEITERS M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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