Provider Demographics
NPI:1134322597
Name:CLOCK, SHAWNA RENEE (MA)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:RENEE
Last Name:CLOCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 HORTON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2600
Mailing Address - Country:US
Mailing Address - Phone:913-722-2505
Mailing Address - Fax:
Practice Address - Street 1:5845 HORTON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2600
Practice Address - Country:US
Practice Address - Phone:913-722-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health