Provider Demographics
NPI:1538840749
Name:REED, SHENOAH JEAN
Entity type:Individual
Prefix:
First Name:SHENOAH
Middle Name:JEAN
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 UNIVERSITY AVE NE APT F
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1993
Mailing Address - Country:US
Mailing Address - Phone:612-567-7786
Mailing Address - Fax:763-390-0027
Practice Address - Street 1:10967 UNIVERSITY AVE NE APT F
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55434-1993
Practice Address - Country:US
Practice Address - Phone:612-567-7786
Practice Address - Fax:763-390-0027
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA877963200OtherUMPI