Provider Demographics
NPI:1720319361
Name:LINK, SHARON SUELLEN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SUELLEN
Last Name:LINK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 N LONE ELM AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-7384
Mailing Address - Country:US
Mailing Address - Phone:307-399-6794
Mailing Address - Fax:
Practice Address - Street 1:3125 N LONE ELM AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-7384
Practice Address - Country:US
Practice Address - Phone:307-399-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6781041C0700X
OK29771041C0700X
MO20200114131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106079100Medicaid