Provider Demographics
NPI:1891876058
Name:CHEN, JAN L (CERTIFIED SCHOOL PSY)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:CHEN
Suffix:
Gender:F
Credentials:CERTIFIED SCHOOL PSY
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:CHEN-BUECHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2238 E. GINTER ROAD
Mailing Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85406
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:2238 E. GINTER ROAD
Practice Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-545-2134
Practice Address - Fax:520-545-2120
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
AZADE103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ573114Medicare ID - Type UnspecifiedCERTIFIED SCHOOL PSYCHOLO