Provider Demographics
NPI:1184365744
Name:LANE, SHANNA MICHELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SHANNA
Other - Middle Name:MICHELLE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8033 RAY MEARS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5458
Mailing Address - Country:US
Mailing Address - Phone:865-545-4592
Mailing Address - Fax:865-979-3039
Practice Address - Street 1:8033 RAY MEARS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5458
Practice Address - Country:US
Practice Address - Phone:865-545-4592
Practice Address - Fax:865-979-3039
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker