Susan Ella Shaw, LCSW, ASCW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28482 Issued in MN

Practice address

8301 47TH Ave N
New Hope, MN 55428-4512

Phone

(763) 504-4937

NPI assigned

Sep 25, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1841524634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK COMMONS DR APT 215",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164986",
            "telephone_number": "952-288-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8301 47TH AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554284512",
            "telephone_number": "763-504-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "SUSAN",
        "middle_name": "ELLA",
        "credential": "LCSW, ASCW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-25",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW6073",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kathran Shea
• Ilyssa Siegel, PSYD
• Rachel Siegel, SLP
• Sandaldeep Singh
• Skadi Sport Psychology

• Clinical Social Worker in New Hope, MN
• Providers in New Hope, 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 Nov 15, 2022; 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.