Provider Demographics
NPI:1689050585
Name:JIWA, SHAWNNESSY (JD)
Entity Type:Individual
Prefix:
First Name:SHAWNNESSY
Middle Name:
Last Name:JIWA
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:SHAWNNESSY
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15211 NE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-9032
Mailing Address - Country:US
Mailing Address - Phone:405-824-9116
Mailing Address - Fax:888-651-6707
Practice Address - Street 1:15211 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-9032
Practice Address - Country:US
Practice Address - Phone:405-824-9116
Practice Address - Fax:888-651-6707
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor