Provider Demographics
NPI:1053153882
Name:BECKERS, SHAWNA MAE (LADC-S, SUPV CPRS)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MAE
Last Name:BECKERS
Suffix:
Gender:F
Credentials:LADC-S, SUPV CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1611
Mailing Address - Country:US
Mailing Address - Phone:612-868-1108
Mailing Address - Fax:
Practice Address - Street 1:7 1ST ST NE APT 6
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-7546
Practice Address - Country:US
Practice Address - Phone:612-868-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselor