Provider Demographics
NPI:1902235369
Name:ENDRES, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ENDRES
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 1:2000 W SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-5603
Mailing Address - Country:US
Mailing Address - Phone:309-687-7919
Mailing Address - Fax:
Practice Address - Street 1:2000 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5603
Practice Address - Country:US
Practice Address - Phone:309-687-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor