Individual
SHAMSO IMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1908 KRUCHTEN CT S, SARTELL, MN 56377-4645
(320) 640-7660
(320) 774-1104
Mailing address
720 8TH AVE N, SAINT CLOUD, MN 56303-3420
(320) 420-4469
(320) 774-1104
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305859
MN
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/19/2023
Last updated
05/04/2024
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