Provider Demographics
NPI:1588036974
Name:CHANDLER, DEMIA (MENTAL HEALTH TECH)
Entity Type:Individual
Prefix:
First Name:DEMIA
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:MENTAL HEALTH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-2821
Mailing Address - Country:US
Mailing Address - Phone:219-240-8615
Mailing Address - Fax:219-977-1197
Practice Address - Street 1:4747 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-2821
Practice Address - Country:US
Practice Address - Phone:219-240-8615
Practice Address - Fax:219-977-1197
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0806442376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide