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Individual

MRS. GERALDINE CHAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
4005 W 65TH ST, SUITE 108, EDINA, MN 55435-1720
(952) 922-9090
(952) 929-0022
Mailing address
4005 W 65TH ST, SUITE 108, EDINA, MN 55435-1720
(952) 922-9090
(952) 929-0022

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3463
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01011769
PREFERRED ONE
MN
01
8B827CH
BLUE CROSS BLUE SHIELD
MN
Enumeration date
01/05/2007
Last updated
07/08/2007
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