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General NPI Number Information
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NPI Number | 1417953951
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Entity Type | Individual
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Provider Name | SHIRLEY J RADER PHD
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 801 ROOSEVELT AVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3703
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Country | US
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Telephone | 218-847-5401
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Fax | 218-573-2350
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Provider Business Mailing Address
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Address Line | PO BOX 1594
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City | DETROIT LAKES
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State | MN
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Zip | 56502-1594
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Country | US
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Telephone | 218-847-5401
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Fax | 218-573-2350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP3342
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 320
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License Number State | ND
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