Provider Demographics
NPI:1427615764
Name:KLEIN, SHELBY ELIZABETH
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:KLEIN
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 1:4494 STONEVIEW PL SE APT 271
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4311
Mailing Address - Country:US
Mailing Address - Phone:507-401-1994
Mailing Address - Fax:
Practice Address - Street 1:401 16TH ST SE STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7973
Practice Address - Country:US
Practice Address - Phone:507-516-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305446101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)