Provider Demographics
NPI:1962717140
Name:TIMS, CHELSEA DAWN (MS SLP)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:DAWN
Last Name:TIMS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12391 SW 109TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3710
Mailing Address - Country:US
Mailing Address - Phone:305-733-2105
Mailing Address - Fax:
Practice Address - Street 1:12391 SW 109TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3710
Practice Address - Country:US
Practice Address - Phone:305-733-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist