Provider Demographics
NPI:1073575999
Name:CHREST, ROSALIN ARDELE (LICSW)
Entity type:Individual
Prefix:
First Name:ROSALIN
Middle Name:ARDELE
Last Name:CHREST
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROSALIN
Other - Middle Name:ARDELE
Other - Last Name:THINGELSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4543 OLIVER AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1124
Mailing Address - Country:US
Mailing Address - Phone:651-260-6512
Mailing Address - Fax:
Practice Address - Street 1:4543 OLIVER AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1124
Practice Address - Country:US
Practice Address - Phone:651-260-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1029315OtherPREFERRED ONE
HP34501OtherHEALTH PARTNERS
6261828OtherUBH
168060OtherU CARE
MN288623500Medicaid
MN407T9CHOtherBCBS
MN407T9CHOtherBCBS
MN800001426Medicare ID - Type Unspecified