MEDICARE: TASHA CHEMPLAVIL LLC

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	261QH0700X	Hearing and Speech Clinic/Center	SP-1602	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255826343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TASHA CHEMPLAVIL LLC

Provider Business Mailing Address
First Line	:	6624 ANGELINA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2920
Country	:	US
Telephone Number	:	702-339-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	6624 ANGELINA ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2920
Country	:	US
Telephone Number	:	702-339-5475
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TASHA CHEMPLAVIL
Credential	:	MS, CCC-SLP
Telephone Number	:	702-339-5475

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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