Provider Demographics
NPI:1033503107
Name:ST PAUL, SHAD BURNETT (MSW, SUDP, LICSW)
Entity Type:Individual
Prefix:MR
First Name:SHAD
Middle Name:BURNETT
Last Name:ST PAUL
Suffix:
Gender:M
Credentials:MSW, SUDP, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:6228 E. OLD SCHOOL RD
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040
Mailing Address - Country:US
Mailing Address - Phone:509-258-7502
Mailing Address - Fax:509-258-4480
Practice Address - Street 1:6228 E. OLD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:509-258-7502
Practice Address - Fax:509-258-4480
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60472921101YA0400X, 101YA0400X
WALW613814271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical