Provider Demographics
NPI:1700838083
Name:SHANKS, ROXANE JANETTE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ROXANE
Middle Name:JANETTE
Last Name:SHANKS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1836
Mailing Address - Country:US
Mailing Address - Phone:641-752-1585
Mailing Address - Fax:641-752-9665
Practice Address - Street 1:9 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1836
Practice Address - Country:US
Practice Address - Phone:641-752-1585
Practice Address - Fax:641-752-9665
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00937104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP08519OtherJOHN DEERE/UBH
IA0058230Medicaid
IA05823OtherBCBS
IA234831OtherMIDLANDS CHOICE
IA05823OtherMEDICARE
IA037100OtherHEALTH ALLIANCE
IA321119OtherVALUE OPTIONS
IA05823OtherMEDICARE