Provider Demographics
NPI:1861275059
Name:HAWLEY, SHANE RYAN (ADC-T, MS)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:RYAN
Last Name:HAWLEY
Suffix:
Gender:M
Credentials:ADC-T, MS
Other - Prefix:
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Mailing Address - Street 1:832 FAIRVIEW AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1017
Mailing Address - Country:US
Mailing Address - Phone:651-329-8688
Mailing Address - Fax:
Practice Address - Street 1:1400 ENERGY PARK DR STE 21
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5248
Practice Address - Country:US
Practice Address - Phone:651-252-6144
Practice Address - Fax:651-252-6071
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)