Provider Demographics
NPI:1457407793
Name:THOMERSON, SHAWNA D (MSW, CSW)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:D
Last Name:THOMERSON
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8133
Mailing Address - Country:US
Mailing Address - Phone:859-498-8664
Mailing Address - Fax:
Practice Address - Street 1:400 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1147
Practice Address - Country:US
Practice Address - Phone:859-744-4482
Practice Address - Fax:858-737-2426
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2636104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker