Provider Demographics
NPI:1598474124
Name:CHIAT, ALISSA
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:CHIAT
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 1:1475 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6512
Mailing Address - Country:US
Mailing Address - Phone:952-242-6114
Mailing Address - Fax:
Practice Address - Street 1:790 CLEVELAND AVE S STE 211
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3845
Practice Address - Country:US
Practice Address - Phone:612-245-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical