Provider Demographics
NPI:1326635269
Name:CHLAM, JOSH
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:CHLAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 LISA DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1145
Mailing Address - Country:US
Mailing Address - Phone:330-621-2000
Mailing Address - Fax:
Practice Address - Street 1:431 LISA DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1145
Practice Address - Country:US
Practice Address - Phone:330-621-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0301211251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services