Provider Demographics
NPI:1558722728
Name:JAHN, CHELSEA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:JAHN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 W ROSE HILL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1653
Mailing Address - Country:US
Mailing Address - Phone:208-450-5321
Mailing Address - Fax:
Practice Address - Street 1:3223 W ROSE HILL ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1653
Practice Address - Country:US
Practice Address - Phone:208-450-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104742176B00000X
NM18177R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife