Provider Demographics
NPI:1518415074
Name:BURNETT, KAWANA LA'SHAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAWANA
Middle Name:LA'SHAYE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KAWANA
Other - Middle Name:L
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 N KEYSTONE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2499
Mailing Address - Country:US
Mailing Address - Phone:773-638-9767
Mailing Address - Fax:
Practice Address - Street 1:11 MUNICIPAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:773-638-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0226001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical