Marie Theresa Shackelford, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW36042 Issued in ID

Practice address

600 N Robbins Rd
Boise, ID 83702-4565

Phone

(208) 385-3245

Fax

(208) 489-4053

NPI assigned

Dec 28, 2016

Last updated

Dec 28, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1174068217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N ROBBINS RD",
            "address_2": "ST LUKE'S REHAB HOSPITAL",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-385-3245",
            "fax_number": "208-489-4053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N ROBBINS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024565",
            "telephone_number": "208-385-3245",
            "fax_number": "208-489-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "MARIE",
        "middle_name": "THERESA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW36042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madelaine Marie Seyer, CF-SLP
• Steven E Seyfert, RPH
• Eliza Shabire
• Colleen M Shackelford, NP
• James Ryan Shackelford, MD
• Teresa I Shackelford, LCSW
• Marie Ann Shade, LCPC
• Cyrah Jade Shaff, DPT
• Cassidy Shaffer, LCSW
• Deborah K. Shaffer, LMSW, QSUDP

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.