Provider Demographics
NPI:1710464425
Name:WADDELL, SHIANN (LMSW)
Entity Type:Individual
Prefix:
First Name:SHIANN
Middle Name:
Last Name:WADDELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1614
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7303
Practice Address - Country:US
Practice Address - Phone:563-582-0145
Practice Address - Fax:888-526-5456
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker