Provider Demographics
NPI:1780217448
Name:FENSKE, CHAYLA (BA)
Entity Type:Individual
Prefix:
First Name:CHAYLA
Middle Name:
Last Name:FENSKE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 RAHN WAY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2300
Mailing Address - Country:US
Mailing Address - Phone:320-220-5522
Mailing Address - Fax:
Practice Address - Street 1:2030 RAHN WAY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2300
Practice Address - Country:US
Practice Address - Phone:651-529-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician