Provider Demographics
NPI:1073618971
Name:SHAKOW, CAROL B (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:B
Last Name:SHAKOW
Suffix:
Gender:F
Credentials:MSW 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 11572
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:360-620-0692
Mailing Address - Fax:
Practice Address - Street 1:345 KNECHTAL WAY NE
Practice Address - Street 2:SUITE #102
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-1476
Practice Address - Fax:206-780-8581
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004136104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker