Individual
PATRICIA JEAN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
3133 HENNEPIN AVE, MINNEAPOLIS, MN 55408-2620
(612) 834-7780
(612) 624-3744
Mailing address
3108 HENNEPIN AVE, MINNEAPOLIS, MN 55408-2619
(612) 825-4407
(612) 825-0768
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
4075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
921813100
—
MN
Enumeration date
09/20/2006
Last updated
09/29/2015
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