Provider Demographics
NPI:1275118846
Name:REITMEIER, SHELBY L (LICSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:REITMEIER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SAINT LOUIS AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2464
Mailing Address - Country:US
Mailing Address - Phone:218-214-2793
Mailing Address - Fax:
Practice Address - Street 1:1900 SAINT LOUIS AVE APT 415
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2464
Practice Address - Country:US
Practice Address - Phone:218-214-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN253931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical