Provider Demographics
NPI:1326419797
Name:CALLIHAN, SHANETHA (MSW)
Entity Type:Individual
Prefix:
First Name:SHANETHA
Middle Name:
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHANETHA
Other - Middle Name:
Other - Last Name:CALLIHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW RSW
Mailing Address - Street 1:5431 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6044
Mailing Address - Country:US
Mailing Address - Phone:225-964-5000
Mailing Address - Fax:225-442-1447
Practice Address - Street 1:5431 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-964-5000
Practice Address - Fax:225-442-1447
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1326419797Medicaid