Individual
SHANNON BREITKREUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.
Contact information
Practice address
107 CEDAR ST, SUITE 7, MONTICELLO, MN 55362-4504
(763) 732-3351
Mailing address
21530 201ST ST NW, BIG LAKE, MN 55309-8118
(763) 772-5382
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3496
MN
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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