Provider Demographics
NPI:1477242006
Name:COOPER, SHAWNA RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RAE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 NE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2505
Mailing Address - Country:US
Mailing Address - Phone:515-571-4877
Mailing Address - Fax:
Practice Address - Street 1:614 BILLY SUNDAY RD STE 100
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8048
Practice Address - Country:US
Practice Address - Phone:515-337-1764
Practice Address - Fax:515-337-0480
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076888104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker