Provider Demographics
NPI:1174664189
Name:SHANKLAND, MARILYN ALTHOFF
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ALTHOFF
Last Name:SHANKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 N WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4418
Mailing Address - Country:US
Mailing Address - Phone:816-863-5674
Mailing Address - Fax:816-453-4674
Practice Address - Street 1:5412 N WYANDOTTE ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-4418
Practice Address - Country:US
Practice Address - Phone:816-863-5674
Practice Address - Fax:816-453-4674
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health