Individual
DR. KENNETH MARSHALL CHAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4005 W 65TH ST, SUITE 108, EDINA, MN 55435-1720
(952) 922-9090
(952) 929-0022
Mailing address
6509 RYAN AVE, EDINA, MN 55435-1518
(952) 922-9090
(952) 929-0022
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
MN LP2329
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075466
VALUEOPTIONS
MN
01
—
4616961
AETNA
MN
01
—
59609CH
BLUE CROSS BLUE SHIELD
MN
01
—
874001
PREFERREDONE PPO
MN
Enumeration date
01/04/2007
Last updated
07/08/2007
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