Individual
DR. SHANNON THOMAS WOULFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., LP
Contact information
Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4673
MN
Other
Enumeration date
02/07/2019
Last updated
03/11/2021
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