Provider Demographics
NPI:1528397288
Name:ALEXANDER, SHANNON C (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:C
Other - Last Name:LURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5728
Mailing Address - Country:US
Mailing Address - Phone:701-952-9600
Mailing Address - Fax:701-952-9601
Practice Address - Street 1:715 10TH ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5728
Practice Address - Country:US
Practice Address - Phone:701-952-9600
Practice Address - Fax:701-952-9601
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
ND446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist