MEDICARE: ROBERT CHADWICK

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	101Y00000X	Counselor	CG6014536	WA

General Provider Information

NPI Number	:	1750513990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CHADWICK

Provider Business Mailing Address
First Line	:	141 URBAN AVE
Second Line	:
City	:	NACHES
State	:	WA
Zip	:	98937-9667
Country	:	US
Telephone Number	:	509-930-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 URBAN AVE
Second Line	:
City	:	NACHES
State	:	WA
Zip	:	98937-9667
Country	:	US
Telephone Number	:	509-930-5466
Fax Number	:

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

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	03/21/2012

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