Individual
TRACEY SHOEMAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
1485 81ST AVE NE, SPRING LAKE PARK, MN 55432-2111
(763) 780-3036
Mailing address
5600 HOLIDAY RD, MINNETONKA, MN 55345-5417
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3750
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108248
UCARE
MN
01
—
5483166-00
MA
MN
01
—
61D95SH
BLUE CROSS
MN
01
—
62-22415
MEDICA
MN
01
—
HP27880
HEALTH PARTNERS
MN
Enumeration date
09/15/2006
Last updated
07/08/2007
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