Individual
DIANA L CHAMBLIN-BEVIRT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
4700 MEMORIAL DR, BELLEVILLE, IL 62226-5373
(618) 257-5775
Mailing address
1225 SIMMONS RD, O FALLON, IL 62269-6608
(618) 632-4335
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.003549
IL
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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