Provider Demographics
NPI:1508339573
Name:CHAMBERLIN, CHASIDY
Entity Type:Individual
Prefix:
First Name:CHASIDY
Middle Name:
Last Name:CHAMBERLIN
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 1:19230 EVANS ST NW STE 203
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1574
Mailing Address - Country:US
Mailing Address - Phone:612-248-1455
Mailing Address - Fax:
Practice Address - Street 1:19230 EVANS ST NW STE 203
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1574
Practice Address - Country:US
Practice Address - Phone:612-248-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor