Provider Demographics
NPI:1477009041
Name:ANDREWS, SHANNON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LCSW
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 1575
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1575
Mailing Address - Country:US
Mailing Address - Phone:208-967-6895
Mailing Address - Fax:208-277-0766
Practice Address - Street 1:9494 N GOVERNMENT WAY # 103
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9848
Practice Address - Country:US
Practice Address - Phone:208-967-6895
Practice Address - Fax:208-277-0766
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IDLCSW-360391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8139486-3501OtherUTAH LICENSE
IDLCSW-36039OtherPROFESSIONAL STATE LICENSE