Provider Demographics
NPI:1225471428
Name:WOLBERT, CHELSEA CHELSEA
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:CHELSEA
Last Name:WOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 COUGAR RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9143
Mailing Address - Country:US
Mailing Address - Phone:360-348-6414
Mailing Address - Fax:
Practice Address - Street 1:4170 COUGAR RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9143
Practice Address - Country:US
Practice Address - Phone:360-348-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602959655103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA271071030Medicaid