Provider Demographics
NPI:1962011635
Name:TALBOT, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:TALBOT
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 1:19591 STATION ST APT 308
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9436
Mailing Address - Country:US
Mailing Address - Phone:612-242-2519
Mailing Address - Fax:
Practice Address - Street 1:19591 STATION ST APT 308
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-9436
Practice Address - Country:US
Practice Address - Phone:612-242-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health