Provider Demographics
NPI:1477997807
Name:NEIL, SHANA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:MARIE
Last Name:NEIL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 1ST AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4848
Mailing Address - Country:US
Mailing Address - Phone:319-364-8741
Mailing Address - Fax:319-368-8096
Practice Address - Street 1:2750 1ST AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4848
Practice Address - Country:US
Practice Address - Phone:319-364-8741
Practice Address - Fax:319-368-8096
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist