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Individual

MR. SHANE RYAN HAWLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ADC-T, MS

Contact information

Practice address
1400 ENERGY PARK DR STE 21, SAINT PAUL, MN 55108-5248
(651) 252-6144
(651) 252-6071
Mailing address
832 FAIRVIEW AVE N, SAINT PAUL, MN 55104-1017
(651) 329-8688

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
08/14/2023
Last updated
08/14/2023
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