Provider Demographics
NPI:1487161972
Name:SMITH, SHANNON MARY JAAKOLA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARY JAAKOLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26246 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-9998
Mailing Address - Country:US
Mailing Address - Phone:612-296-7295
Mailing Address - Fax:612-872-2955
Practice Address - Street 1:26246 CRANE RD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-9998
Practice Address - Country:US
Practice Address - Phone:612-296-7295
Practice Address - Fax:612-872-2955
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist