NPIMap

Organization Active NPI

Carita R Shawchuck PHD PC

  • Clinical Child & Adolescent Psychologist
  • Fargo, ND
National Provider Identifier
1871650267
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
CARITA R SHAWCHUCK PHD PC
Practice address
1351 Page Dr S
Suite 105
Fargo, ND 58103-3502
Phone
(701) 893-3419
Fax
(701) 356-8801
NPI assigned
Jan 3, 2007
Last updated
Dec 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Authorized official

Name
Dr. Carita Renee Shawchuck, PH.D.NPI 1093757791
Title
President
Phone
(701) 893-3419

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X Primary

Addresses

Primary practice location

1351 Page Dr S
Suite 105
Fargo, ND 58103-3502

Mailing address

1351 Page Dr S
Suite 105
Fargo, ND 58103-3502
Phone (701) 893-3419

Other identifiers 2

IdentifierTypeStateIssuer
06753001OtherNDND BLUE SHIELD
86G13SHOtherMNMN BLUE SHEILD

National Provider Directory

National Provider Directory
Tax ID family
Carita R Shawchuck PHD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1351 Page Dr S
Ste 105
Fargo, ND 58103
Phone (701) 893-3419

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197417600000",
    "number": "1871650267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S",
            "address_2": "SUITE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033502",
            "telephone_number": "701-893-3419",
            "fax_number": "701-356-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S",
            "address_2": "SUITE 105",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033502",
            "telephone_number": "701-893-3419",
            "fax_number": "701-356-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARITA R SHAWCHUCK PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-12-12",
        "status": "A",
        "authorized_official_last_name": "SHAWCHUCK",
        "authorized_official_first_name": "CARITA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-893-3419",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE SHIELD",
            "identifier": "06753001",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BLUE SHEILD",
            "identifier": "86G13SH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2007; 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.