Provider Demographics
NPI:1760493936
Name:HOFER, SHAWN LEE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LEE
Last Name:HOFER
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LONG LAKE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6439
Mailing Address - Country:US
Mailing Address - Phone:651-482-9361
Mailing Address - Fax:651-482-9888
Practice Address - Street 1:900 LONG LAKE RD STE 320
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6439
Practice Address - Country:US
Practice Address - Phone:651-482-9361
Practice Address - Fax:651-482-9888
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical