Individual provider Active NPI

Lori A. Shaleen, PH.D.

  • Psychologist
  • Minot, ND
National Provider Identifier
1356487821
Registry record updated Oct 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
ND 362 Issued in ND
Practice address
1015 S Broadway
Suite 18
Minot, ND 58701-4667
Phone
(701) 857-8500
Fax
(701) 857-8555
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X ND 362 ND Primary

Addresses

Primary practice location

1015 S Broadway
Suite 18
Minot, ND 58701-4667

Mailing address

1015 S Broadway
Suite 18
Minot, ND 58701-4667
Phone (701) 857-8500

Other identifiers 1

IdentifierTypeStateIssuer
54517MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150318002490 MN Practitioner - Clinical Psychologist 9739210055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
University of North Dakota School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Mental Health Center IncGroup PAC ID 1759291891, 39 clinicians

Practice addresses (Care Compare)

1010 S 32ND Ave
Moorhead, MN 56560-5001
Phone (218) 233-7524

980 S Tower Rd
Fergus Falls, MN 56537-5505
Phone (218) 736-6987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
ND 362NDMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Mental Health Center, Inc. CurrentSince Jan 12, 2015 Accepting new patients

Locations

980 S Tower Rd
Fergus Falls, MN 56537
Phone (218) 736-6987

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287360000000",
    "number": "1356487821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S BROADWAY",
            "address_2": "SUITE 18",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014667",
            "telephone_number": "701-857-8500",
            "fax_number": "701-857-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S BROADWAY",
            "address_2": "SUITE 18",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014667",
            "telephone_number": "701-857-8500",
            "fax_number": "701-857-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHALEEN",
        "first_name": "LORI",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2010-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ND",
            "license": "ND 362",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54517",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minot, ND

Sources for this page

Verify at the official NPI Registry.