Provider Demographics
NPI:1457612327
Name:CHEN, DARAH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DARAH
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 SW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4212
Mailing Address - Country:US
Mailing Address - Phone:954-383-0640
Mailing Address - Fax:
Practice Address - Street 1:1861 SW 36TH TER
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4212
Practice Address - Country:US
Practice Address - Phone:954-383-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010897300Medicaid
FLSA11055OtherFLORIDA DEPARTMENT OF HEALTH