Provider Demographics
NPI:1932936283
Name:SHIVELY, STEPHANIE LYNNE (PHD, MA)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:PHD, MA
Other - Prefix:DR
Other - First Name:STEVI
Other - Middle Name:
Other - Last Name:SHIVELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, MA
Mailing Address - Street 1:15301 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12301 WHITEWATER DR STE 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-4157
Practice Address - Country:US
Practice Address - Phone:952-999-6097
Practice Address - Fax:952-426-0508
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health