SHAWN RAE DISTERHAUPT

BRAINERD, MN
NPI1942996087
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: MN  26111)
Enumeration Date2023-04-12
Last Update Date2023-04-12
Business Address
SHAWN RAE DISTERHAUPT
606 FRONT ST
BRAINERD, MN 56401-3602
Phone number: 218-232-6247
Mailing Address
SHAWN RAE DISTERHAUPT
203 H ST NE
BRAINERD, MN 56401-2404
Phone number:
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