Provider Demographics
NPI:1295210094
Name:CHEA, CHENDA
Entity Type:Individual
Prefix:
First Name:CHENDA
Middle Name:
Last Name:CHEA
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 1:3606 48TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5879
Mailing Address - Country:US
Mailing Address - Phone:612-730-8896
Mailing Address - Fax:
Practice Address - Street 1:3606 48TH STNW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-5879
Practice Address - Country:US
Practice Address - Phone:612-730-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency