CARITA R SHAWCHUCK (NPI# 1093757791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093757791 |
| Entity Type | Individual |
| Full Name | CARITA R SHAWCHUCK |
| Credential | PHD PC |
| Practice Address |
1121 Westrac Dr S Suite 204 Fargo ND 58103-8716 |
| Practice Telephone | 7018660624 |
| Practice Fax Number | 7013568801 |
| Mailing Telephone | 7018660624 |
| Mailing Fax Number | 7013568801 |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-09-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
295 | ND | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | ND BLUE SHIELD | 26500 | 01 |
| Street Address |
1121 WESTRAC DR S SUITE 204 |
| City | FARGO |
| State | ND |
| Zip Code | 58103-8716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528486396 | Jennifer Torgerson | Massage Therapist | 1121 Westrac Dr S, 102, Fargo, ND 58103-8716 | 2014-03-30 |
| 1063750966 | Lynette Danuser | Massage Therapist | 1121 Westrac Dr S, Suite 102, Fargo, ND 58103-8716 | 2013-01-28 |
| 1740530633 | Michelle Lee Bierdeman | Massage Therapist | 1121 Westrac Dr S, Suite 102, Fargo, ND 58103-8716 | 2012-09-18 |
| 1871736371 | Arlis Ann Mccauley | Counselor | 1121 Westrac Dr S, 104, Fargo, ND 58103-8716 | 2009-04-14 |
| 1275636888 | June Marie Forde | Counselor | 1121 Westrac Dr S, #204, Fargo, ND 58103-8716 | 2006-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437715166 | Diana Rose Slivensky | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2019-05-17 |
| 1609205988 | Robyn Maley | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2013-11-06 |
| 1649604869 | Daniel Barrett Landauer | Psychologist | 1711 University Dr S, Fargo, ND 58103-4939 | 2013-08-23 |
| 1013269257 | Carita R Shawchuck, Phd, PC | Psychologist | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2012-10-12 |
| 1962782268 | Sanford Medical Center Fargo | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2011-08-18 |
| 1124218961 | Sanford Clinic North | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2007-07-27 |
| 1871650267 | Carita R Shawchuck Phd PC | Psychologist | 1351 Page Dr S, Suite 105, Fargo, ND 58103-3502 | 2007-01-03 |
| 1497776736 | Rebecca Suzanne Preussler | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1912243148 | Beacon Behavioral Health Services | Psychologist | 102 W Beaton Dr, Suite 103, West Fargo, ND 58078-2652 | 2012-12-16 |
| 1972756583 | Shyla L Muse | Psychologist | 3535 S 31st St Ste 201, Grand Forks, ND 58201 | 2008-10-28 |
| 1770549032 | Catherine Yeager | Psychologist | 3535 S 31st St Ste 201, Grand Forks, ND 58201-3593 | 2006-04-25 |
Please comment or provide details below to improve the information on CARITA R SHAWCHUCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.