Provider Demographics
NPI:1588879514
Name:CHAPIN, CHERYL MAE (MS, LPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MAE
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1420
Mailing Address - Country:US
Mailing Address - Phone:715-823-2710
Mailing Address - Fax:715-823-4885
Practice Address - Street 1:119 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1420
Practice Address - Country:US
Practice Address - Phone:715-823-2710
Practice Address - Fax:715-823-4885
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI893-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI108214450074OtherHUMANA