Provider Demographics
NPI:1164520284
Name:SHAGALOW, JOSEPH (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SHAGALOW
Suffix:
Gender:M
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 FRANCE AVE
Mailing Address - Street 2:STE 327
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4310
Mailing Address - Country:US
Mailing Address - Phone:952-835-2002
Mailing Address - Fax:952-835-9889
Practice Address - Street 1:7200 FRANCE AVE
Practice Address - Street 2:STE 327
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4310
Practice Address - Country:US
Practice Address - Phone:952-835-2002
Practice Address - Fax:952-835-9889
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6192891OtherMEDICA
MN150R5BHOtherBCBS
MN171138OtherUCARE
MNHP39213OtherHEALTH PARTNERS