Provider Demographics
NPI:1578810669
Name:JUNGBLUTH, CHELSY ROSE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:CHELSY
Middle Name:ROSE
Last Name:JUNGBLUTH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVENUE SOUTH MAIL STOP 560
Mailing Address - Street 2:CHILDRENS HOSPITAL & CLINICS OF MINNESOTA
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-813-6271
Mailing Address - Fax:612-813-6360
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:MAIL STOP 560
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-6271
Practice Address - Fax:612-813-6360
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS