Individual
HAYLY JEAN SHACKLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
7601 WAYZATA BLVD, ST LOUIS PARK, MN 55426-1623
(612) 223-8898
Mailing address
508 98TH LN NE, BLAINE, MN 55434-1354
(612) 817-0590
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
30474
MN
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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