Provider Demographics
NPI:1306197751
Name:GRAF, SHELLY DENAE (LICSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DENAE
Last Name:GRAF
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 1:13024 89TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9513
Mailing Address - Country:US
Mailing Address - Phone:612-306-4575
Mailing Address - Fax:763-271-2707
Practice Address - Street 1:13024 89TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-9513
Practice Address - Country:US
Practice Address - Phone:612-306-4575
Practice Address - Fax:763-271-2707
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN189361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical