MEDICARE: WENDY LACHANCE M.A.

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
1	235Z00000X	Speech-Language Pathologist	SP.04612	OH

General Provider Information

NPI Number	:	1578336814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY LACHANCE M.A.

Provider Business Mailing Address
First Line	:	150 N MILLER RD # BDLG150A
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 GEORGETOWN RD NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44704-2257
Country	:	US
Telephone Number	:	330-453-5902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	10/30/2023

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Directions to “ WENDY LACHANCE M.A.” Practice Location

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