Provider Demographics
NPI:1720439649
Name:SHETKA, GERI (LPCC)
Entity type:Individual
Prefix:
First Name:GERI
Middle Name:
Last Name:SHETKA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CENTRAL AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5221
Mailing Address - Country:US
Mailing Address - Phone:507-338-0699
Mailing Address - Fax:507-323-8204
Practice Address - Street 1:220 CENTRAL AVE N STE 100
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5221
Practice Address - Country:US
Practice Address - Phone:507-338-0699
Practice Address - Fax:507-323-8204
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional