Provider Demographics
NPI:1578362745
Name:CRUMBLEHOLME, CHELSEA KAY (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KAY
Last Name:CRUMBLEHOLME
Suffix:
Gender:
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 36TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6632
Mailing Address - Country:US
Mailing Address - Phone:309-948-1209
Mailing Address - Fax:
Practice Address - Street 1:8258 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1631
Practice Address - Country:US
Practice Address - Phone:708-598-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.016654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist