Provider Demographics
NPI:1558549907
Name:SHOEN, KRISTINE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:SHOEN
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 1:117 DOWNTOWN PLZ
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-1726
Mailing Address - Country:US
Mailing Address - Phone:507-399-2149
Mailing Address - Fax:507-399-2159
Practice Address - Street 1:112 W 1ST ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1743
Practice Address - Country:US
Practice Address - Phone:507-399-2149
Practice Address - Fax:507-399-2159
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health