Healthcare Provider Details

I. General information

NPI: 1114083029
Provider Name (Legal Business Name): SHIRLEE CORRINE LANSING LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 90TH ST NE, SUITE 200 NYSTROM & ASSOCIATES, LTD.
OTSEGO MN
55330
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW SUITE 110
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-9492
  • Fax: 763-746-3685
Mailing address:
  • Phone: 651-628-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0728
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: