Provider Demographics
NPI:1245816701
Name:SANTMYER, SHARLENE MAY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:MAY
Last Name:SANTMYER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1620
Mailing Address - Country:US
Mailing Address - Phone:218-499-7000
Mailing Address - Fax:218-499-7001
Practice Address - Street 1:1102 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1620
Practice Address - Country:US
Practice Address - Phone:218-499-7000
Practice Address - Fax:218-499-7001
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN262521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical