Doctor Name: | DIANA L CHAMBLIN-BEVIRT |
NPI Number: | 1912261264 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | 146.003549 |
Business Practice Address: | 4700 Memorial Dr Belleville, IL - 622265373 |
Business Phone Number: | 6182575775 |
Business Fax Number: | |
Mailing Address: | 1225 Simmons Rd, O FALLON |
State: | IL |
Postal Code: | 622696608 |
Phone Number: | 6186324335 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2012 |
NPI Last Update Date: | 07/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146.003549 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |