Individual
MS. SHELLY ELAINE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
7757 LAMONT AVE NE, OTSEGO, MN 55301-4066
(612) 616-8401
Mailing address
7757 LAMONT AVE NE, OTSEGO, MN 55301-4066
(612) 616-8401
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
16068
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261943100
—
MN
01
—
922241046607
PREFERRED ONE
—
Enumeration date
06/27/2006
Last updated
09/30/2011
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