Provider Demographics
NPI:1659558179
Name:POLSON, SHANNON (LCSW, PIP, RN, CNL)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:POLSON
Suffix:
Gender:F
Credentials:LCSW, PIP, RN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 FOUNDERS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4143
Mailing Address - Country:US
Mailing Address - Phone:205-588-5722
Mailing Address - Fax:205-942-6770
Practice Address - Street 1:651 BEACON PKWY W
Practice Address - Street 2:STE 202B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3141
Practice Address - Country:US
Practice Address - Phone:205-588-5722
Practice Address - Fax:205-942-6770
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2181C1041C0700X
AL1-126757163WA0400X, 163WA2000X, 163WC0400X, 163WC1500X, 163WD0400X, 163WM0705X, 163WX0200X, 163WP0808X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care