Individual
MS. ANDREA DAWN SHELLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19285 HIGHWAY 7, EXCELSIOR, MN 55331-9131
(612) 483-3812
Mailing address
16575 FIVE HAWKS AVE SE, PRIOR LAKE, MN 55372-2438
(612) 483-3812
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1370
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1370
LICENSE NUMBER
MN
Enumeration date
11/08/2006
Last updated
07/08/2007
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