Individual
MRS. SHELBY R BANKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LADC
Contact information
Practice address
13603 80TH CIR N, MAPLE GROVE, MN 55369-8961
(763) 274-3120
Mailing address
13603 80TH CIR N, MAPLE GROVE, MN 55369-8961
(763) 274-3120
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305153
MN
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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