MEDICARE: CEMELIA CHANEY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548008220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEMELIA CHANEY

Provider Business Mailing Address
First Line	:	2759 LONG VIEW DR
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-9507
Country	:	US
Telephone Number	:	419-902-7398
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 LONG VIEW DR
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-9507
Country	:	US
Telephone Number	:	419-902-7398
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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Directions to “ CEMELIA CHANEY ” Practice Location

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