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General NPI Number Information
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NPI Number | 1558549907
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Entity Type | Individual
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Provider Name | KRISTINE MARIE SHOEN LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 112 W 1ST ST SUITE 104
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City | FAIRMONT
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State | MN
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Zip | 56031-1743
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Country | US
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Telephone | 507-399-2149
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Fax | 507-399-2159
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Provider Business Mailing Address
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Address Line | 117 DOWNTOWN PLZ SUITE 104
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City | FAIRMONT
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State | MN
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Zip | 56031-1726
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Country | US
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Telephone | 507-399-2149
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Fax | 507-399-2159
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17553
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License Number State | MN
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