Provider Demographics
NPI:1396488474
Name:SEIBEL, SHANNON MARIE (MS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:SEIBEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25958 474TH ST
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:MN
Mailing Address - Zip Code:56461-4870
Mailing Address - Country:US
Mailing Address - Phone:218-407-0596
Mailing Address - Fax:
Practice Address - Street 1:25958 474TH ST
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:MN
Practice Address - Zip Code:56461-4870
Practice Address - Country:US
Practice Address - Phone:218-407-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health