Provider Demographics
NPI:1568846996
Name:SHAW, MICHELE L (PLADC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3056
Mailing Address - Country:US
Mailing Address - Phone:402-435-2273
Mailing Address - Fax:402-435-2274
Practice Address - Street 1:1700 S 24TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3056
Practice Address - Country:US
Practice Address - Phone:402-435-2273
Practice Address - Fax:402-435-2274
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)