Shae Edgerton

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

25080 Issued in MN

Practice address

823 Maple St
Brainerd, MN 56401-3770

Phone

(218) 454-3826

Fax

(218) 454-1024

NPI assigned

Mar 10, 2020

Last updated

Mar 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Northern Pines Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Little Falls, MN
  • NPI 1013904051
  NPD

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1538794524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 MAPLE ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013770",
            "telephone_number": "218-454-3826",
            "fax_number": "218-454-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 MAPLE ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013770",
            "telephone_number": "218-454-3826",
            "fax_number": "218-454-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGERTON",
        "first_name": "SHAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rylea Ellizabeth Durbin
• Kimberly M Dylla, CRNA
• Stephanie Eastman, RN
• Eastwest Counseling and Consulting PLLC
• Easy Hearing Clinic LLC
• Edgewood Brainerd Senior Living LLC
• Deanne Ehlert
• Christa A Eickhoff, M.D.
• Jeffrey Charles Eickhoff, M.D.
• Jeremiah John Eisenschenk, M.D.

• Clinical Social Worker in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.