Basic Information
| Provider Information | |||||||||
| NPI: | 1235689019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHATTERTON | ||||||||
| FirstName: | JUSTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PHD LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512415200 | ||||||||
| FaxNumber: | 6512416427 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512415200 | ||||||||
| FaxNumber: | 6512416427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2016 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.