Provider Demographics
NPI:1154061489
Name:SHANNON, DAWN (CSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 WOODHAVEN PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2809
Mailing Address - Country:US
Mailing Address - Phone:502-876-4208
Mailing Address - Fax:
Practice Address - Street 1:1228 ASHLEY CIR STE 5
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5803
Practice Address - Country:US
Practice Address - Phone:270-495-1222
Practice Address - Fax:859-209-6504
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64041041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker