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Individual

BRENDA CHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SPEECH THERAPIST

Contact information

Practice address
3401 SOLDIERS HOME RD., WEST LAFAYETTE, IN 47906
(765) 463-1541
(765) 497-0687
Mailing address
2837 HENDERSON AVE., WEST LAFAYETTE, IN 47906-1540
(765) 497-0655
(765) 497-0655

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22001474A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000243264
ANTHEM PIN #
IN
Enumeration date
04/26/2007
Last updated
01/17/2012
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