| Organization Name: | CARITA R SHAWCHUCK, PHD, PC |
| NPI Number: | 1013269257 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARITA R SHAWCHUCK (OWNER) |
| Mailing Address: | 1121 Westrac Dr S Ste 204 Fargo |
| State: | ND US |
| Postal Code: | 581032385 |
| Phone Number: | 7018933419 |
| Fax Number: | 7013568801 |
| NPI Enumeration Date: | 10/12/2012 |
| NPI Last Update Date: | 10/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 295 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |