Provider Demographics
NPI:1194191064
Name:SMITH-JEFFERSON, SHAWNA K (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:K
Last Name:SMITH-JEFFERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4843
Mailing Address - Country:US
Mailing Address - Phone:317-473-5524
Mailing Address - Fax:
Practice Address - Street 1:221 S WOLF RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4843
Practice Address - Country:US
Practice Address - Phone:317-473-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006927A1041C0700X
IL1490176741041C0700X
IN101345091041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool