Individual
ELLIOT SHIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10505 WAYZATA BLVD STE 203-3, MINNETONKA, MN 55305-1502
(952) 222-7936
Mailing address
2043 UTAH AVE S, ST LOUIS PARK, MN 55426-2401
(952) 456-2396
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/29/2023
Last updated
09/07/2023
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