Provider Demographics
NPI:1043480692
Name:SHAUGHNESSY, JAN EILENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:EILENE
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S. COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709
Mailing Address - Country:US
Mailing Address - Phone:208-376-3677
Mailing Address - Fax:208-376-3730
Practice Address - Street 1:226 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0934
Practice Address - Country:US
Practice Address - Phone:208-376-3677
Practice Address - Fax:208-376-3730
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW272071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical