Active NPI
Shannon L Wilson, LCSW
- Clinical Social Worker
- Mountain Home Afb, ID
National Provider Identifier
1013396175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-36402
- Practice address
- 90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062 - Phone
- (208) 288-7580
- NPI assigned
- May 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-36402 | ID | Primary |
| Social Worker | 104100000X | LMSW-33063 | ID |
Addresses
Primary practice location
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Mailing address
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Phone (208) 828-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-33063 | ID | MD | Social Worker |
| LCSW-36402 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764547200000",
"number": "1013396175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-828-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-288-7580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHANNON",
"middle_name": "L",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-22",
"last_updated": "2025-12-01",
"certification_date": "2025-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-36402",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LMSW-33063",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home Afb, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.