Provider Demographics
NPI:1740543842
Name:EVERS, SHANNON BROOKE (MSW, LISW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:BROOKE
Last Name:EVERS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:309 E 5TH STREET SEVA COUNSELING
Mailing Address - Street 2:#202
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1983
Mailing Address - Country:US
Mailing Address - Phone:515-423-0284
Mailing Address - Fax:515-864-0497
Practice Address - Street 1:309 E 5TH STREET SEVA COUNSELING
Practice Address - Street 2:#202
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1983
Practice Address - Country:US
Practice Address - Phone:515-423-0284
Practice Address - Fax:515-864-0497
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0079591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2117182Medicaid