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General NPI Number Information
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NPI Number | 1912261264
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Entity Type | Individual
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Provider Name | DIANA L CHAMBLIN-BEVIRT M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 4700 MEMORIAL DR
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City | BELLEVILLE
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State | IL
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Zip | 62226-5373
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Country | US
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Telephone | 618-257-5775
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 SIMMONS RD
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City | O FALLON
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State | IL
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Zip | 62269-6608
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Country | US
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Telephone | 618-632-4335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.003549
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License Number State | IL
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