Provider Demographics
NPI:1740332063
Name:WRIGHT, SHAWNA D (PHD)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:D
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:402 SOUTH KANSAS
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720
Mailing Address - Country:US
Mailing Address - Phone:620-431-7890
Mailing Address - Fax:620-431-7927
Practice Address - Street 1:402 SOUTH KANSAS
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720
Practice Address - Country:US
Practice Address - Phone:620-431-7890
Practice Address - Fax:620-431-7927
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1236103TC0700X, 103TC2200X, 103TM1800X
KS1236103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119837OtherBLUE SHIELD
KS119837Medicare ID - Type Unspecified