| Jeff Shively, Msw, Licsw | |
|
12805 Highway 55 Suite 200 Plymouth MN 55441-3880 | |
| (612) 723-0408 | |
| (763) 210-5379 |
| Full Name | Jeff Shively, Msw, Licsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 12805 Highway 55, Plymouth, Minnesota |
| Authorized Official Name and Position | Jeff W Shively (PRESIDENT) |
| Authorized Official Contact | 6127230408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeff Shively, Msw, Licsw 12805 Highway 55 Suite 200 Plymouth MN 55441-3880 Ph: (612) 723-0408 | Jeff Shively, Msw, Licsw 12805 Highway 55 Suite 200 Plymouth MN 55441-3880 Ph: (612) 723-0408 |
| NPI Number | 1366874299 |
|---|---|
| Provider Enumeration Date | 08/02/2013 |
| Last Update Date | 08/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366874299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 18053 (Minnesota) | Primary |
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