Healthcare Provider Details

I. General information

NPI: 1255052973
Provider Name (Legal Business Name): SHANDRA SCHULZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANDRA SZCZUR, DVORAK

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 42ND ST S STE B
FARGO ND
58104-4032
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 701-501-8014
  • Fax: 701-941-4504
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30438
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5415
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: