Provider Demographics
NPI:1679942833
Name:GRONEWOLD, CHELSEY ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:ANN
Last Name:GRONEWOLD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:ANN
Other - Last Name:ROCKVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2965 E TARPON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9007
Mailing Address - Country:US
Mailing Address - Phone:208-287-9420
Mailing Address - Fax:208-287-9426
Practice Address - Street 1:800 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6781
Practice Address - Country:US
Practice Address - Phone:701-852-1399
Practice Address - Fax:701-838-0613
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDSLP-1453OtherLICENSE