Provider Demographics
NPI:1992907927
Name:SHASKEY-SETRIGHT, CARL FRANK (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:FRANK
Last Name:SHASKEY-SETRIGHT
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 BROADWAY ST
Mailing Address - Street 2:STE. 170
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2718
Mailing Address - Country:US
Mailing Address - Phone:320-762-5124
Mailing Address - Fax:320-762-2422
Practice Address - Street 1:1804 BROADWAY ST
Practice Address - Street 2:STE. 170
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2718
Practice Address - Country:US
Practice Address - Phone:320-762-5124
Practice Address - Fax:320-762-2422
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH237SE-WWOtherBLUE CROSS
MN71052900WWMedicaid