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NPI Code Detail

MEDICARE: SHANNON JEAN MAXWELL PSY.D, LP

MEDICARE: SHANNON JEAN MAXWELL PSY.D, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist530SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790058089
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON JEAN MAXWELL PSY.D, LP
Provider Business Mailing Address
First Line : 115 N 7TH ST STE 6
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-645-0100
Fax Number : 605-717-1009
Provider Business Practice Location Address
First Line : 115 N 7TH ST STE 6
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-645-0100
Fax Number : 605-717-1009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2012
Last Update Date : 01/20/2026

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