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General NPI Number Information
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NPI Number | 1871805614
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Entity Type | Individual
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Provider Name | BRITT NICOLE SHACKELFORD WESSEL PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 3503 HIGH POINT DRIVE N BLDG 3, SUITE 230
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City | OAKDALE
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State | MN
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Zip | 55128-6158
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Country | US
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Telephone | 612-787-7050
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Fax | 612-844-2784
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Provider Business Mailing Address
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Address Line | 3503 HIGH POINT DRIVE N BLDG 3, SUITE 230
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City | OAKDALE
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State | MN
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Zip | 55128-6158
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Country | US
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Telephone | 612-787-7050
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Fax | 612-844-2784
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP5297
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License Number State | MN
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