Provider Demographics
NPI:1962870865
Name:LINK, SHANA (MA COUNSELING PSYC)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:LINK
Suffix:
Gender:F
Credentials:MA COUNSELING PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 4TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2427
Mailing Address - Country:US
Mailing Address - Phone:763-210-9966
Mailing Address - Fax:
Practice Address - Street 1:901 4TH ST STE 205
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-2427
Practice Address - Country:US
Practice Address - Phone:763-210-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health