Provider Demographics
NPI:1902590805
Name:ST. CLOUD STATE UNIVERSITY
Entity Type:Organization
Organization Name:ST. CLOUD STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN, COLLEGE OF HEALTH & WELLNESS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-308-4732
Mailing Address - Street 1:720 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 8TH ST S RM 115
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4423
Practice Address - Country:US
Practice Address - Phone:320-308-4238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA STATE COLLEGES AND UNIVERSITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty