Provider Demographics
NPI:1013775394
Name:ADAMS, SHAWNNA MAE (SUDPT)
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:MAE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:SHAWNNA
Other - Middle Name:MAE
Other - Last Name:BOER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUDPT
Mailing Address - Street 1:420 HOWANUT RD
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-9659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 HOWANUT RD
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568-9659
Practice Address - Country:US
Practice Address - Phone:360-583-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60838249101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)