Provider Demographics
NPI:1710341276
Name:WHITING, SHAWNNA
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:
Last Name:WHITING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4419
Mailing Address - Country:US
Mailing Address - Phone:888-922-2843
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:201 D ST STE G
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5957
Practice Address - Country:US
Practice Address - Phone:530-237-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
KS106S00000X
CAR1224060316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician