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NPI Code Detail

MEDICARE: CHANDRE LYNN WHITE RBT

MEDICARE: CHANDRE LYNN WHITE RBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-152053CA
2106S00000XBehavior TechnicianRBT-24-346573

General Provider Information

NPI Number : 1265013114
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANDRE LYNN WHITE RBT
Provider Business Mailing Address
First Line : 4721 S CLIFF AVE STE 103
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-6969
Country : US
Telephone Number : 816-608-1956
Fax Number : 800-687-5070
Provider Business Practice Location Address
First Line : 338 BROADWAY ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63701-7367
Country : US
Telephone Number : 573-708-7250
Fax Number : 800-687-5070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 01/17/2025

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Directions to “ CHANDRE LYNN WHITE RBT” Practice Location

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