Provider Demographics
NPI:1437835790
Name:SEXTON, SHANNA ZOE (SC61208216)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:ZOE
Last Name:SEXTON
Suffix:
Gender:F
Credentials:SC61208216
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16667
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-0667
Mailing Address - Country:US
Mailing Address - Phone:206-678-3531
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 617
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1100
Practice Address - Country:US
Practice Address - Phone:206-678-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC612082161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical