Healthcare Provider Details

I. General information

NPI: 1093632325
Provider Name (Legal Business Name): SHEILAH R DUDLEY LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 ARIEL ST N STE D
MAPLEWOOD MN
55109-2202
US

IV. Provider business mailing address

1344 SAINT PAUL AVE APT 7
SAINT PAUL MN
55116-2752
US

V. Phone/Fax

Practice location:
  • Phone: 651-770-1311
  • Fax: 651-770-1879
Mailing address:
  • Phone: 651-770-1311
  • Fax: 651-770-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35731
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: