Healthcare Provider Details

I. General information

NPI: 1477539690
Provider Name (Legal Business Name): CHARLENE E CORDES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 COLDWATER RD SUITE 107
FORT WAYNE IN
46825-2096
US

IV. Provider business mailing address

9604 COLDWATER RD SUITE 101
FORT WAYNE IN
46825-2096
US

V. Phone/Fax

Practice location:
  • Phone: 260-387-5820
  • Fax: 260-828-7823
Mailing address:
  • Phone: 260-387-5820
  • Fax: 260-828-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number230002344A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: