Provider Demographics
NPI:1639237852
Name:FRENZEN, SHANNA LEE (MA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEE
Last Name:FRENZEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 MITCHELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1959
Mailing Address - Country:US
Mailing Address - Phone:952-224-2282
Mailing Address - Fax:952-224-2284
Practice Address - Street 1:7525 MITCHELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1959
Practice Address - Country:US
Practice Address - Phone:952-224-2282
Practice Address - Fax:952-224-2284
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1639237852Medicaid