Provider Demographics
NPI:1205865425
Name:SHAKER, ROSANNE TURNER (PHD)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:TURNER
Last Name:SHAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ABBY WOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1253
Mailing Address - Country:US
Mailing Address - Phone:361-290-9318
Mailing Address - Fax:
Practice Address - Street 1:6 ABBY WOOD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1253
Practice Address - Country:US
Practice Address - Phone:361-290-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16JZOtherBLUE CROSS/BLUE SHIELD TX
TX113169004Medicaid
TX113169004Medicaid