Provider Demographics
NPI:1497796072
Name:CHEPLE, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CHEPLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3706
Mailing Address - Country:US
Mailing Address - Phone:888-333-9152
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:20 THOMPSON AVE E
Practice Address - Street 2:# 204
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3187
Practice Address - Country:US
Practice Address - Phone:651-455-9724
Practice Address - Fax:651-455-9726
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5175237600000X
MN2249237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN336365100Medicaid
MN640000265Medicare ID - Type UnspecifiedIND PROV ID NUMBER