Provider Demographics
NPI:1922982230
Name:EWING, DAVID SHANE (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SHANE
Last Name:EWING
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:DAVE
Other - Middle Name:
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:1707 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-0080
Mailing Address - Country:US
Mailing Address - Phone:517-673-3413
Mailing Address - Fax:
Practice Address - Street 1:6375 W 143RD ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2888
Practice Address - Country:US
Practice Address - Phone:952-592-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35057104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker