Provider Demographics
NPI:1205909017
Name:HAIRY SHIRT, JOANNE CAROL (CSW-PIP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:CAROL
Last Name:HAIRY SHIRT
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:CAROL
Other - Last Name:BARRENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:40703 128TH ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445-5431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40703 128 ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445
Practice Address - Country:US
Practice Address - Phone:605-454-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
SD30101041C0700X
SD3040104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker