Provider Demographics
NPI:1538291315
Name:HARDY, SHADEE ALEA (LICSW)
Entity type:Individual
Prefix:
First Name:SHADEE
Middle Name:ALEA
Last Name:HARDY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 HARMON PL
Mailing Address - Street 2:SUITE 300J
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1916
Mailing Address - Country:US
Mailing Address - Phone:612-345-8115
Mailing Address - Fax:612-486-5537
Practice Address - Street 1:1624 HARMON PL
Practice Address - Street 2:SUITE 300J
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1916
Practice Address - Country:US
Practice Address - Phone:612-345-8115
Practice Address - Fax:612-486-5537
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker