Healthcare Provider Details

I. General information

NPI: 1679647531
Provider Name (Legal Business Name): KRIS CHAFFEE PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONG LAKE RD STE 160
NEW BRIGHTON MN
55112-6414
US

IV. Provider business mailing address

900 LONG LAKE RD STE 160
NEW BRIGHTON MN
55112-6414
US

V. Phone/Fax

Practice location:
  • Phone: 612-706-9630
  • Fax: 612-706-9617
Mailing address:
  • Phone: 612-706-9630
  • Fax: 612-706-9617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP7029
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: