Provider Demographics
NPI:1568965580
Name:ELBANDAGJI, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ELBANDAGJI
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:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2400
Mailing Address - Country:US
Mailing Address - Phone:319-596-5910
Mailing Address - Fax:319-352-1993
Practice Address - Street 1:2022 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2010
Practice Address - Country:US
Practice Address - Phone:319-596-5910
Practice Address - Fax:319-352-1993
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker