Individual
DR. SHIRLEY J RADER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
801 ROOSEVELT AVE, DETROIT LAKES, MN 56501-3703
(218) 847-5401
(218) 573-2350
Mailing address
PO BOX 1594, DETROIT LAKES, MN 56502-1594
(218) 847-5401
(218) 573-2350
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
320
ND
103TC1900X
Counseling Psychologist
Primary
LP3342
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01019338
PREFERRED ONE PROVIDER #
MN
05
—
10857
—
ND
01
—
19698RAD
ND BLUE CROSS BLUE SHIELD
ND
01
—
6G302RA
MN BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/21/2005
Last updated
07/09/2007
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