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General NPI Number Information
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NPI Number | 1144895210
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Entity Type | Individual
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Provider Name | HAILEY BOURGEAU CHANG PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 41 LEOPARD RD STE 304
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City | PAOLI
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State | PA
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Zip | 19301-1549
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Country | US
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Telephone | 610-647-6406
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Fax |
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Provider Business Mailing Address
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Address Line | 126 CRICKET DR
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City | MALVERN
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State | PA
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Zip | 19355-1547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS-019165
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License Number State | PA
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