Provider Demographics
NPI:1477846624
Name:REINER, SHANNON (LICSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:REINER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57890 226TH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-5704
Mailing Address - Country:US
Mailing Address - Phone:320-221-4051
Mailing Address - Fax:320-693-8560
Practice Address - Street 1:101 S GORMAN AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2427
Practice Address - Country:US
Practice Address - Phone:320-593-0526
Practice Address - Fax:320-593-0536
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical