Healthcare Provider Details

I. General information

NPI: 1760493936
Provider Name (Legal Business Name): SHAWN LEE HOFER PH.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONG LAKE RD STE 320
NEW BRIGHTON MN
55112-6439
US

IV. Provider business mailing address

900 LONG LAKE RD STE 320
NEW BRIGHTON MN
55112-6439
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-9361
  • Fax: 651-482-9888
Mailing address:
  • Phone: 651-482-9361
  • Fax: 651-482-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 4695
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: