Provider Demographics
NPI:1912203613
Name:CRAFT, SHONDA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHONDA
Middle Name:MARIE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WILLOW STREET
Mailing Address - Street 2:SUITE 520
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2086
Mailing Address - Country:US
Mailing Address - Phone:612-223-8086
Mailing Address - Fax:612-223-8086
Practice Address - Street 1:1409 WILLOW STREET
Practice Address - Street 2:SUITE 520
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2086
Practice Address - Country:US
Practice Address - Phone:612-223-8086
Practice Address - Fax:612-223-8086
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist