MEDICARE: CHAENEY L BROWN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1932711272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAENEY L BROWN

Provider Business Mailing Address
First Line	:	4244 IRISH HILLS DR APT 3D
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-3175
Country	:	US
Telephone Number	:	219-393-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2014 LINCOLNWAY E STE 3
Second Line	:
City	:	GOSHEN
State	:	IN
Zip	:	46526-6818
Country	:	US
Telephone Number	:	800-210-0814
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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