Provider Demographics
NPI:1073916417
Name:CHASTANET, RONDILIENNE NICHOLE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:RONDILIENNE
Middle Name:NICHOLE
Last Name:CHASTANET
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:RONDILIENNE
Other - Middle Name:NICHOLE
Other - Last Name:CHASTANET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:7601 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1623
Mailing Address - Country:US
Mailing Address - Phone:763-447-0712
Mailing Address - Fax:
Practice Address - Street 1:7601 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1623
Practice Address - Country:US
Practice Address - Phone:763-447-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist