Organization
BRENDAN SHANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN C SHANE LICSW (OWNER)
(952) 334-9390
Entity
Organization
Contact information
Practice address
7575 GOLDEN VALLEY RD, SUITE 370, GOLDEN VALLEY, MN 55427-4562
(952) 334-9390
Mailing address
6513 CREEK DR, EDINA, MN 55439-1207
(952) 334-9390
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13192
MN
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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