Provider Demographics
NPI:1841025467
Name:LODGE, SHAWNA D (CD(DONA), CLC)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:D
Last Name:LODGE
Suffix:
Gender:F
Credentials:CD(DONA), CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:IL
Mailing Address - Zip Code:61233-0431
Mailing Address - Country:US
Mailing Address - Phone:309-292-0362
Mailing Address - Fax:
Practice Address - Street 1:524 15TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2170
Practice Address - Country:US
Practice Address - Phone:309-737-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula