Provider Demographics
NPI:1083496749
Name:FREEMAN, SHAYLYN
Entity Type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:
Last Name:FREEMAN
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 1:102 SPRUCE ST SE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55935-8825
Mailing Address - Country:US
Mailing Address - Phone:507-884-2445
Mailing Address - Fax:
Practice Address - Street 1:102 SPRUCE ST SE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:MN
Practice Address - Zip Code:55935-8825
Practice Address - Country:US
Practice Address - Phone:507-884-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health