Provider Demographics
NPI:1487081147
Name:AUSTER SHANESY, MARY (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:AUSTER SHANESY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2813
Mailing Address - Country:US
Mailing Address - Phone:608-576-2146
Mailing Address - Fax:
Practice Address - Street 1:1155 COUNTY ROAD E E
Practice Address - Street 2:SUITE 100
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-5183
Practice Address - Country:US
Practice Address - Phone:651-241-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical