Provider Demographics
NPI:1770279085
Name:SHOPEK, EMILY MAE (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:SHOPEK
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 1:7767 ELM CREEK BLVD N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7041
Mailing Address - Country:US
Mailing Address - Phone:612-354-6647
Mailing Address - Fax:
Practice Address - Street 1:15620 24TH AVE N UNIT C
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-6487
Practice Address - Country:US
Practice Address - Phone:612-354-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN203961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical