Provider Demographics
NPI:1265724694
Name:SHAKLAN, SANDRA A (MSW, LCSW-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:A
Last Name:SHAKLAN
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:7070 SAMUEL MORSE DR
Practice Address - Street 2:KAISER PERMANENTE COLUMBIA GATEWAY MEDICAL CENTER
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3424
Practice Address - Country:US
Practice Address - Phone:410-309-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical