1508548462 NPI number — CHRYSA REICHEL LGSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508548462 NPI number — CHRYSA REICHEL LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICHEL
Provider First Name:
CHRYSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMPHREY
Provider Other First Name:
CHRYSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508548462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2510 LEXINGTON AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENDOTA HEIGHTS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55120-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-422-8850
Provider Business Mailing Address Fax Number:
651-455-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 LEXINGTON AVE. S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDOTA HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-280-5359
Provider Business Practice Location Address Fax Number:
651-455-1385
Provider Enumeration Date:
08/01/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  28078 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)