Provider Demographics
NPI:1629938824
Name:HELGOTH, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HELGOTH
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 1:1108 W 61ST ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1517
Mailing Address - Country:US
Mailing Address - Phone:308-440-4779
Mailing Address - Fax:
Practice Address - Street 1:303 W CHURCH STREET
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:NE
Practice Address - Zip Code:68866
Practice Address - Country:US
Practice Address - Phone:308-388-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool