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NPI Code Detail

MEDICARE: CHELSEA RAE VONDEISENROTH

MEDICARE:   CHELSEA RAE VONDEISENROTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1043729957
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHELSEA RAE VONDEISENROTH
Provider Business Mailing Address
First Line : 91 BENTLEY AVE
Second Line :
City : LOS GATOS
State : CA
Zip : 95030-6002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 228 HAMILTON AVE FL 3
Second Line :
City : PALO ALTO
State : CA
Zip : 94301-2583
Country : US
Telephone Number : 408-674-6591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2017
Last Update Date : 08/29/2022

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Directions to “ CHELSEA RAE VONDEISENROTH ” Practice Location

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