Provider Demographics
NPI:1073717070
Name:COLLINS, SHAWNEE DEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:DEE
Last Name:COLLINS
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 1:127 ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9827
Mailing Address - Country:US
Mailing Address - Phone:801-360-4756
Mailing Address - Fax:
Practice Address - Street 1:570 E 1400 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7714
Practice Address - Country:US
Practice Address - Phone:801-426-6661
Practice Address - Fax:801-426-6660
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5422498-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical