Healthcare Provider Details

I. General information

NPI: 1558068528
Provider Name (Legal Business Name): CHELSEY SHANTELLE MORRIS RDH, PHDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 REVERE RD
CLINTON IL
61727-2914
US

IV. Provider business mailing address

457 TYRONE DR
FORSYTH IL
62535-1069
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-3427
  • Fax: 217-935-9820
Mailing address:
  • Phone: 217-935-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020012339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: