Provider Demographics
NPI:1003633736
Name:CROARKIN, SHAUNA MARIE (EDS, NCSP)
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:MARIE
Last Name:CROARKIN
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BARR ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3502
Mailing Address - Country:US
Mailing Address - Phone:260-467-1124
Mailing Address - Fax:260-467-1188
Practice Address - Street 1:1200 BARR ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3502
Practice Address - Country:US
Practice Address - Phone:260-467-1124
Practice Address - Fax:260-467-1188
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10101976103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool