Active NPI
Shannon Walsdorf, PHD, MSW, LCSW
- Clinical Social Worker
- Mandeville, LA
National Provider Identifier
1053702043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11202
- Practice address
- 4005 Azalea CT
Mandeville, LA 70448-7044 - Phone
- (985) 373-8609
- NPI assigned
- Feb 11, 2015
- Last updated
- Feb 11, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11202 | LA | Primary |
Addresses
Primary practice location
4005 Azalea CT
Mandeville, LA 70448-7044
Mailing address
4005 Azalea CT
Mandeville, LA 70448-7044
Phone (985) 373-8609
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11202 | LA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1053702043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 AZALEA CT",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704487044",
"telephone_number": "985-373-8609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 AZALEA CT",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704487044",
"telephone_number": "985-373-8609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSDORF",
"first_name": "SHANNON",
"name_prefix": "Dr.",
"credential": "PHD, MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-11",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "11202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.