Provider Information for 1770073918
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DERRELL J CHANDLER MSW, LISW-CP
Sex: Female
NPI: 1770073918
Last Updated: 2018-05-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1770073918 | ||||||||
| Enumeration Date | 2018-05-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1410 30TH AVE NW APT 5113 MINOT, ND 58703-5085 United States Phone: 843-909-1677 | Fax: | ||||||||
| Primary Practice Address | 475 SUMMIT DR MINOT, ND 58705-5010 United States Phone: 843-909-1677 | Fax: | ||||||||
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