Provider Demographics
NPI:1710139928
Name:GAUNT, SHANA L (MSW, LICSWA, MHP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:L
Last Name:GAUNT
Suffix:
Gender:F
Credentials:MSW, LICSWA, MHP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:L
Other - Last Name:LANNIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:5060 S HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8242
Mailing Address - Country:US
Mailing Address - Phone:509-251-0471
Mailing Address - Fax:
Practice Address - Street 1:5060 S HILLCREST LN
Practice Address - Street 2:
Practice Address - City:VERADALE
Practice Address - State:WA
Practice Address - Zip Code:99037-8242
Practice Address - Country:US
Practice Address - Phone:509-203-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC606957551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical