Shannon Breitkreutz, L.P.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3496 Issued in MN

Practice address

107 Cedar St
Suite 7
Monticello, MN 55362-4504

Phone

(763) 732-3351

NPI assigned

Nov 29, 2012

Last updated

Nov 29, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Roman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 9, 2024 through Feb 9, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Healing Moments Counseling LLC

  • Community/Behavioral Health Agency
  • Monticello, MN
  • NPI 1043505373
  NPD (past)

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1538404736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21530 201ST ST NW",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553098118",
            "telephone_number": "763-772-5382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 CEDAR ST",
            "address_2": "SUITE 7",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553624504",
            "telephone_number": "763-732-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREITKREUTZ",
        "first_name": "SHANNON",
        "credential": "L.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ROMAN",
            "credential": "L.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark W Bonneville, MD
• Jessica Borgstrom, CNM
• Joanna Borrell
• Rachel Brandt, PHARMD
• Danielle Sarah Brant, BES, BS, LADC, LICSW
• Brenner Dental Group
• Angela M. Brown, OTR/L
• Anna Bruggeman
• Shaylei Mae Brutger, MS, RD, LD
• Michael Buchman, PT, DPT

• Psychologist in Monticello, MN
• Providers in Monticello, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.