Provider Demographics
NPI:1003301243
Name:HUELSNITZ, SHAWNA MAE (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:MAE
Last Name:HUELSNITZ
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:MAE
Other - Last Name:VANCIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 AMERICAN BLVD E STE 8
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1230
Mailing Address - Country:US
Mailing Address - Phone:952-767-2276
Mailing Address - Fax:
Practice Address - Street 1:1801 AMERICAN BLVD E STE 8
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1230
Practice Address - Country:US
Practice Address - Phone:529-767-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRBT-16-19532106S00000X
MN3342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician