Provider Demographics
NPI:1568965580
Name:ELBANDAGJI, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ELBANDAGJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:MOHAMMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:215 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2715
Mailing Address - Country:US
Mailing Address - Phone:619-559-5769
Mailing Address - Fax:
Practice Address - Street 1:200 STATE ST STE 202K
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-3380
Practice Address - Country:US
Practice Address - Phone:619-559-5769
Practice Address - Fax:319-575-6028
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1104231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical