Shawn Rae Disterhaupt
NPI 1942996087ActiveIndividual· Social Worker, Clinical· Brainerd, MN
Social Worker, Clinical in Brainerd, Minnesota, licensed in MN, with an NPI issued in April 2023. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1942996087 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Apr 12, 2023 |
| Last updated in NPPES | Apr 12, 2023 |
| Certified by provider | Apr 12, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 26111 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (MN) |
|---|
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