Healthcare Provider Details

I. General information

NPI: 1205426103
Provider Name (Legal Business Name): CHRISTINE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE SMITH

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9769 CROSSPOINT BLVD
INDIANAPOLIS IN
46256-3531
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 317-588-2732
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46760
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: