Healthcare Provider Details

I. General information

NPI: 1588452643
Provider Name (Legal Business Name): JACQUELINE CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ELTON HILLS DR NW
ROCHESTER MN
55901-2476
US

IV. Provider business mailing address

3331 68TH ST SE
ROCHESTER MN
55904-6903
US

V. Phone/Fax

Practice location:
  • Phone: 507-722-1508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number14409182
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: