Provider Demographics
NPI:1194040790
Name:MCLAUGHLIN, SHANNON M (LCSW, CCDP-D)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:LCSW, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2847
Mailing Address - Fax:
Practice Address - Street 1:30 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-3800
Practice Address - Country:US
Practice Address - Phone:814-223-9900
Practice Address - Fax:814-223-9914
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128571104100000X
PACW0181021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029614190001Medicaid
PA1029614190001Medicaid