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1942996087
SHAWN RAE DISTERHAUPT
BRAINERD, MN
NPI
1942996087
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MN 26111)
Enumeration Date
2023-04-12
Last Update Date
2023-04-12
Business Address
SHAWN RAE DISTERHAUPT
606 FRONT ST
BRAINERD, MN 56401-3602
Phone number: 218-232-6247
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Mailing Address
SHAWN RAE DISTERHAUPT
203 H ST NE
BRAINERD, MN 56401-2404
Phone number:
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