Provider Demographics
NPI:1417770983
Name:ZAMUDIO, CHELSEA
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E ELM ST
Mailing Address - Street 2:1/2
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3430
Mailing Address - Country:US
Mailing Address - Phone:612-448-4896
Mailing Address - Fax:
Practice Address - Street 1:311 E ELM ST
Practice Address - Street 2:1/2
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3430
Practice Address - Country:US
Practice Address - Phone:612-448-4896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician