Organization
JEFF SHIVELY, MSW, LICSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF W SHIVELY LICSW (PRESIDENT)
(612) 723-0408
Entity
Organization
Contact information
Practice address
12805 HIGHWAY 55, SUITE 200, PLYMOUTH, MN 55441-3880
(612) 723-0408
(763) 210-5379
Mailing address
12805 HIGHWAY 55, SUITE 200, PLYMOUTH, MN 55441-3880
(612) 723-0408
(763) 210-5379
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18053
MN
Other
Enumeration date
08/02/2013
Last updated
08/03/2013
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