Provider Demographics
NPI:1508629544
Name:CAREY, SHAWNA L
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:CAREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 MCKNIGHT RD N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4401
Mailing Address - Country:US
Mailing Address - Phone:651-367-4599
Mailing Address - Fax:
Practice Address - Street 1:3878 MCKNIGHT RD N
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4401
Practice Address - Country:US
Practice Address - Phone:651-367-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical