MEDICARE: SIMON CHAN

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	101YM0800X	Mental Health Counselor	04916	IA

General Provider Information

NPI Number	:	1235334467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON CHAN

Provider Business Mailing Address
First Line	:	2005 ASBURY RD
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-3042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	449 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4205
Country	:	US
Telephone Number	:	319-337-4204
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ SIMON CHAN ” Practice Location

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