Provider Demographics
NPI:1629419502
Name:OUTLER, SHANNAN (MSW)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:OUTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 JAMESTOWN BLVD APT 2230
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4634
Mailing Address - Country:US
Mailing Address - Phone:786-269-8779
Mailing Address - Fax:321-396-7574
Practice Address - Street 1:800 S EUSTIS ST STE E
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4886
Practice Address - Country:US
Practice Address - Phone:352-729-1860
Practice Address - Fax:321-396-7574
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker