MEDICARE: MR. RANDY CHAPMAN

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	1954539	IL

General Provider Information

NPI Number	:	1992221667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY CHAPMAN

Provider Business Mailing Address
First Line	:	3200 MARYVILLE RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 MARYVILLE RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5144
Country	:	US
Telephone Number	:	618-451-5826
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	08/16/2017

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Directions to “ MR. RANDY CHAPMAN ” Practice Location

Language	Start Address	Practice Location

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