Provider Demographics
NPI:1306395124
Name:FENSKE, SHAUNA (MA)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:FENSKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE A, B, AND E
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2929
Mailing Address - Country:US
Mailing Address - Phone:612-787-2832
Mailing Address - Fax:
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE A, B, AND E
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2929
Practice Address - Country:US
Practice Address - Phone:612-787-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist