Healthcare Provider Details

I. General information

NPI: 1083535355
Provider Name (Legal Business Name): KALIE BRYANNE CHAMBLESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N COLUMBIA RD
GRAND FORKS ND
58203-2817
US

IV. Provider business mailing address

3500 RUEMMELE RD APT 101
GRAND FORKS ND
58201-6087
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-3745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: