MEDICARE: CHELSEA TILLMAN SLP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	235Z00000X	Speech-Language Pathologist	NE
2	235Z00000X	Speech-Language Pathologist	NM
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124495874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA TILLMAN SLP

Provider Business Mailing Address
First Line	:	3651 MAJESTA ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-4674
Country	:	US
Telephone Number	:	505-215-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

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

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	06/05/2019

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Directions to “ CHELSEA TILLMAN SLP” Practice Location

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