Provider Demographics
NPI:1164065868
Name:CHINNOCK, KAREN NICOLE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:NICOLE
Last Name:CHINNOCK
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:NICOLE
Other - Last Name:GUSZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:1957 SCHOOLMASTER DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4554
Mailing Address - Country:US
Mailing Address - Phone:732-979-3767
Mailing Address - Fax:
Practice Address - Street 1:930 BLUE GENTIAN RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1674
Practice Address - Country:US
Practice Address - Phone:651-348-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist