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NPI Code Detail

MEDICARE: CHANDA LICHTSINN SLP

MEDICARE: CHANDA LICHTSINN SLP
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
1235Z00000XSpeech-Language Pathologist22003366AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200621390OTHERINFIRST STEPS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457495418
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANDA LICHTSINN SLP
Provider Business Mailing Address
First Line : 3703 ARLINGTON AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-2301
Country : US
Telephone Number : 260-456-4988
Fax Number :
Provider Business Practice Location Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number : 260-497-0328
Fax Number : 260-497-0904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 01/25/2023

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Directions to “ CHANDA LICHTSINN SLP” Practice Location

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