Healthcare Provider Details

I. General information

NPI: 1174368849
Provider Name (Legal Business Name): CHELSEY HARJU, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 RICHARD AVE STE 312
HERMANTOWN MN
55811-3309
US

IV. Provider business mailing address

4140 RICHARD AVE STE 312
HERMANTOWN MN
55811-3309
US

V. Phone/Fax

Practice location:
  • Phone: 218-390-8733
  • Fax:
Mailing address:
  • Phone: 218-390-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHELSEY MARIE HARJU
Title or Position: OWNER, LICSW
Credential: LICSW
Phone: 218-390-8733