Provider Demographics
NPI:1699095661
Name:SHAW, DEANNE T (LMFT)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:T
Last Name:SHAW
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 1:1001 HIGHWAY 7
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4723
Mailing Address - Country:US
Mailing Address - Phone:952-938-7040
Mailing Address - Fax:952-938-4708
Practice Address - Street 1:1001 HIGHWAY 7
Practice Address - Street 2:SUITE 305
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-4723
Practice Address - Country:US
Practice Address - Phone:952-938-7040
Practice Address - Fax:952-938-4708
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist