Provider Demographics
NPI:1447733233
Name:BOGENSCHUTZ, SHANNON MEGHAN (LPCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MEGHAN
Last Name:BOGENSCHUTZ
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W DIVISION ST STE 217
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4557
Mailing Address - Country:US
Mailing Address - Phone:320-253-4120
Mailing Address - Fax:320-253-4179
Practice Address - Street 1:3333 W DIVISION ST STE 217
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4557
Practice Address - Country:US
Practice Address - Phone:320-253-4120
Practice Address - Fax:320-253-4179
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional