Provider Demographics
NPI:1679354856
Name:SHELSTAD-OTTO, KAROLYN
Entity type:Individual
Prefix:
First Name:KAROLYN
Middle Name:
Last Name:SHELSTAD-OTTO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 BRYANT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1429
Mailing Address - Country:US
Mailing Address - Phone:612-803-5920
Mailing Address - Fax:
Practice Address - Street 1:3033 EXCELSIOR BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-5147
Practice Address - Country:US
Practice Address - Phone:651-440-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN04822101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health