Provider Demographics
NPI:1235689019
Name:CHATTERTON, JUSTINE M (PHD LP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:CHATTERTON
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2331
Mailing Address - Country:US
Mailing Address - Phone:651-241-5200
Mailing Address - Fax:651-241-6427
Practice Address - Street 1:233 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2331
Practice Address - Country:US
Practice Address - Phone:651-241-5200
Practice Address - Fax:651-241-6427
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling