Provider Demographics
NPI:1578297776
Name:SHAW, JALYN MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:JALYN
Middle Name:MARIE
Last Name:SHAW
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 1:826 18TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-4371
Mailing Address - Country:US
Mailing Address - Phone:785-675-3018
Mailing Address - Fax:785-675-2306
Practice Address - Street 1:826 18TH ST STE A
Practice Address - Street 2:
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-4371
Practice Address - Country:US
Practice Address - Phone:785-675-3018
Practice Address - Fax:785-675-2306
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12448104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker