Provider Demographics
NPI:1750912929
Name:WOODRUFF, SHANNON LAIRD (MSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAIRD
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23035 COUNTRY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-7875
Mailing Address - Country:US
Mailing Address - Phone:985-634-4380
Mailing Address - Fax:
Practice Address - Street 1:128 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5939
Practice Address - Country:US
Practice Address - Phone:985-651-3777
Practice Address - Fax:985-651-3770
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)