Healthcare Provider Details

I. General information

NPI: 1659286987
Provider Name (Legal Business Name): CHASE NICHOLE RAYMER M.A. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S HERREN AVE
ELLSINORE MO
63937-8208
US

IV. Provider business mailing address

PO BOX 1094
VAN BUREN MO
63965-1094
US

V. Phone/Fax

Practice location:
  • Phone: 537-322-5653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2026039428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: