Individual
MRS. SHELLY MARIE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
11141 ZEALAND AVE N, CHAMPLIN, MN 55316
(763) 951-3091
(763) 951-3097
Mailing address
11141 ZEALAND AVE N, CHAMPLIN, MN 55316-3595
(763) 951-3091
(763) 951-3097
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1139
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407168900
—
MN
Enumeration date
05/31/2006
Last updated
05/18/2018
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