Provider Demographics
NPI:1750927455
Name:CHEMARUM, JOAN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:CHEMARUM
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:CHEMARUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2042 WOODDALE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4394
Mailing Address - Country:US
Mailing Address - Phone:507-338-8608
Mailing Address - Fax:
Practice Address - Street 1:1303 S FRONTAGE RD STE 150
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2690
Practice Address - Country:US
Practice Address - Phone:651-505-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7125103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist