Provider Demographics
NPI:1306604673
Name:SHUCK, VANESSA ANN (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:SHUCK
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 LEXINGTON AVE N STE 205
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8044
Mailing Address - Country:US
Mailing Address - Phone:651-486-3808
Mailing Address - Fax:
Practice Address - Street 1:3490 LEXINGTON AVE N STE 205
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8044
Practice Address - Country:US
Practice Address - Phone:651-486-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31224104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker