Provider Demographics
NPI:1083885818
Name:GALLAGHER, SHAWNA FAY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:FAY
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SHAWNA
Other - Middle Name:FAY
Other - Last Name:HEGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3551 QUEENSLAND CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5141
Mailing Address - Country:US
Mailing Address - Phone:209-983-1469
Mailing Address - Fax:
Practice Address - Street 1:611 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2007
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker