Provider Demographics
NPI:1952164337
Name:FERNANDERS, CHADWICK
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:
Last Name:FERNANDERS
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 1:333 S MAIN ST STE 607
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1228
Mailing Address - Country:US
Mailing Address - Phone:336-896-1324
Mailing Address - Fax:
Practice Address - Street 1:333 S MAIN ST STE 607
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1228
Practice Address - Country:US
Practice Address - Phone:336-896-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty