MEDICARE: BOBBI CHAGOLLA

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	1041C0700X	Clinical Social Worker	23534	AZ

General Provider Information

NPI Number	:	1134086721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBI CHAGOLLA

Provider Business Mailing Address
First Line	:	4657 S LAKESHORE DR STE 1
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7170
Country	:	US
Telephone Number	:	480-718-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	4657 S LAKESHORE DR STE 1
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7170
Country	:	US
Telephone Number	:	480-718-1261
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ BOBBI CHAGOLLA ” Practice Location

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