MEDICARE: CHANDRANI BOSE RAY ST

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	107406	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902930183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRANI BOSE RAY ST

Provider Business Mailing Address
First Line	:	1011 ROSEMEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77094-2917
Country	:	US
Telephone Number	:	847-971-7930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 ROSEMEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77094-2917
Country	:	US
Telephone Number	:	847-971-7930
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	12/29/2011

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Directions to “ CHANDRANI BOSE RAY ST” Practice Location

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