MEDICARE: DAISY CHANG

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	235Z00000X	Speech-Language Pathologist	113164	TX

General Provider Information

NPI Number	:	1609305325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY CHANG

Provider Business Mailing Address
First Line	:	4340 PHYLLIS LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-3552
Country	:	US
Telephone Number	:	817-230-3955
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 OHIO DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-2720
Country	:	US
Telephone Number	:	972-468-6200
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	06/06/2017

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Directions to “ DAISY CHANG ” Practice Location

Language	Start Address	Practice Location

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