Provider Demographics
NPI:1679354856
Name:SHELSTAD-OTTO, KAROLYN
Entity Type:Individual
Prefix:
First Name:KAROLYN
Middle Name:
Last Name:SHELSTAD-OTTO
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 1:4638 BRYANT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1429
Mailing Address - Country:US
Mailing Address - Phone:612-803-5920
Mailing Address - Fax:
Practice Address - Street 1:6120 OREN AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6155
Practice Address - Country:US
Practice Address - Phone:651-439-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health