# CARITA R SHAWCHUCK PHD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871650267
- **Authorized official:** DR. CARITA RENEE SHAWCHUCK PH.D. (PRESIDENT)
- **Authorized official phone:** (701) 893-3419

## Contact information

- **Practice address:** 1351 PAGE DR S, SUITE 105, FARGO, ND 58103-3502
- **Practice address phone:** (701) 893-3419
- **Practice address fax:** (701) 356-8801
- **Mailing address:** 1351 PAGE DR S, SUITE 105, FARGO, ND 58103-3502
- **Mailing address phone:** (701) 893-3419
- **Mailing address fax:** (701) 356-8801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 12/12/2007