Provider Demographics
NPI:1134594112
Name:SHAW, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 W SUNSET HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9446
Mailing Address - Country:US
Mailing Address - Phone:509-209-2739
Mailing Address - Fax:509-471-1701
Practice Address - Street 1:5709 W SUNSET HWY STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9446
Practice Address - Country:US
Practice Address - Phone:509-209-2739
Practice Address - Fax:509-471-1701
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61037789103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst