Provider Demographics
NPI:1598734147
Name:KRONLUND, SHANNON LEA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEA
Last Name:KRONLUND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HENNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 BRUCE ST
Mailing Address - Street 2:PO BOX 603
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-2914
Mailing Address - Country:US
Mailing Address - Phone:218-281-3940
Mailing Address - Fax:218-281-6261
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-281-3940
Practice Address - Fax:218-281-6261
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN159471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26023OtherBCBS OF ND
HP55669OtherHEALTH PARTNERS
1044495OtherPREFERRED ONE
MN136769OtherUCARE MINNESOTA
MN198P8KROtherBCBS OF MN