Individual
BRENDA SHORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1821 UNIVERSITY AVE W, SUITE N 464, SAINT PAUL, MN 55104-2801
(651) 659-2900
(651) 645-7307
Mailing address
1821 UNIVERSITY AVE W, SUITE N 464, SAINT PAUL, MN 55104-2801
(651) 659-2900
(651) 645-7307
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12470
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12470
LICSW
MN
Enumeration date
08/20/2008
Last updated
08/20/2008
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