MEDICARE: CHELSEY NICOLE SUMMERS M.S., 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	112119	TX
2	235Z00000X	Speech-Language Pathologist	SP-2259	NV

General Provider Information

NPI Number	:	1619485471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEY NICOLE SUMMERS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2500 N RAINBOW BLVD APT 1071
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4542
Country	:	US
Telephone Number	:	972-658-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N BUFFALO DR UNIT 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3637
Country	:	US
Telephone Number	:	702-979-4268
Fax Number	:	702-979-1336

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

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	03/15/2018

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Directions to “ CHELSEY NICOLE SUMMERS M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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