Provider Demographics
NPI:1912203613
Name:CRAFT, SHONDA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHONDA
Middle Name:MARIE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 151S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1099
Mailing Address - Country:US
Mailing Address - Phone:515-044-3246
Mailing Address - Fax:651-564-4591
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 151S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1099
Practice Address - Country:US
Practice Address - Phone:651-504-4324
Practice Address - Fax:651-564-4591
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist