Provider Demographics
NPI:1528007192
Name:SHOOK, ANDREA M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:SHOOK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1424
Mailing Address - Country:US
Mailing Address - Phone:812-268-4805
Mailing Address - Fax:812-242-2210
Practice Address - Street 1:701 N. ENGLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-361-9767
Practice Address - Fax:765-361-0374
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003254A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343921OtherANTHEM BCBS PROVIDER PIN
IN000000343921OtherANTHEM BCBS PROVIDER PIN