Provider Demographics
NPI:1073772174
Name:SHOOK, KORAL JO (MSW)
Entity Type:Individual
Prefix:
First Name:KORAL
Middle Name:JO
Last Name:SHOOK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5625
Mailing Address - Country:US
Mailing Address - Phone:307-389-6441
Mailing Address - Fax:
Practice Address - Street 1:2001 DEWAR DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5773
Practice Address - Country:US
Practice Address - Phone:307-382-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker