Provider Demographics
NPI:1891707048
Name:SOUDER, SHIRLEY B (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:B
Last Name:SOUDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 KILBOURN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1920
Mailing Address - Country:US
Mailing Address - Phone:574-295-1613
Mailing Address - Fax:
Practice Address - Street 1:1750 KILBOURN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1920
Practice Address - Country:US
Practice Address - Phone:574-295-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001303A1041C0700X
IN35000647A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical