Individual
KATIE ANN LOUISE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1875 STATION PKWY NW, ANDOVER, MN 55304-3319
(763) 482-9598
Mailing address
4050 147TH LN NW, ANDOVER, MN 55304-3124
(612) 840-9735
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16455LICSW
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061637100
MEDICAL ASSISTANCE MA
—
Enumeration date
11/03/2006
Last updated
10/02/2024
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