Provider Demographics
NPI:1427430735
Name:LEUTSCHAFT, SHELLEY A L (PHD, LP)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:A L
Last Name:LEUTSCHAFT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 DEER TRAIL LN NE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2096
Mailing Address - Country:US
Mailing Address - Phone:507-363-2136
Mailing Address - Fax:972-323-8640
Practice Address - Street 1:1560 DEER TRAIL LN NE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2096
Practice Address - Country:US
Practice Address - Phone:317-743-5539
Practice Address - Fax:972-323-8640
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2023-09-07
Deactivation Date:2017-09-22
Deactivation Code:
Reactivation Date:2018-10-19
Provider Licenses
StateLicense IDTaxonomies
MNLP4834103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist