Provider Demographics
NPI:1932518602
Name:CHANDLER, JEROME (BS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2336
Mailing Address - Country:US
Mailing Address - Phone:313-324-8900
Mailing Address - Fax:
Practice Address - Street 1:1145 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2336
Practice Address - Country:US
Practice Address - Phone:313-324-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISA0823206OtherMICHIGAN DEPT. OF LARA