Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 1236 | KS |
Y | 103G00000X | Clinical Psychologist | LP1236 | KS |
Y | 103TC0700X | Clinical Psychologist | LP1236 | KS |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP1236 | KS |
N | 103TM1800X | Intellectual & Developmental Disabilities | LP1236 | KS |
NPI | 1740332063 |
---|---|
Provider Name | Shawna D Wright |
First Address | Chanute, KS 66720 |
Second Address | Chanute, KS 66720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119837 | BLUE SHIELD (01) | KS |