Provider Demographics
NPI:1972770717
Name:SCOTT-KLUNK, SHANNA LEAH (MSW, LCSW, ACS)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEAH
Last Name:SCOTT-KLUNK
Suffix:
Gender:F
Credentials:MSW, LCSW, ACS
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LEAH
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW, ACS
Mailing Address - Street 1:514 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2508
Mailing Address - Country:US
Mailing Address - Phone:717-721-1752
Mailing Address - Fax:717-674-7428
Practice Address - Street 1:514 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2508
Practice Address - Country:US
Practice Address - Phone:717-721-1752
Practice Address - Fax:717-674-7428
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0190041041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100775933Medicaid