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General NPI Number Information
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NPI Number | 1306731765
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Entity Type | Individual
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Provider Name | CHAZZ CHARLES SPEICHER
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Gender | Male
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 161 ANNA AVE NW
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City | CANTON
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State | OH
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Zip | 44708-5149
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Country | US
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Telephone | 330-936-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 258 MOUNT PLEASANT ST NW
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City | CLINTON
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State | OH
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Zip | 44216-9550
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Country | US
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Telephone | 330-714-4803
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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