Provider Demographics
NPI:1891841300
Name:GULICK, SHAWNA SUE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:SUE
Last Name:GULICK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:SUE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5642 S 244TH RD
Mailing Address - Street 2:
Mailing Address - City:FAIR GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65648-9119
Mailing Address - Country:US
Mailing Address - Phone:417-224-0933
Mailing Address - Fax:
Practice Address - Street 1:5642 S 244TH RD
Practice Address - Street 2:
Practice Address - City:FAIR GROVE
Practice Address - State:MO
Practice Address - Zip Code:65648-9119
Practice Address - Country:US
Practice Address - Phone:417-224-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110146181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical