Shanda Leann Watson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2012003674 Issued in MO

Practice address

310 E Main St
Cole Camp, MO 65325-1240

Phone

(660) 668-0155

Fax

(660) 668-0156

NPI assigned

Jun 7, 2011

Last updated

Feb 13, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329091200000",
    "number": "1306130372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 E MAIN ST",
            "address_2": "PO BOX 194",
            "city": "COLE CAMP",
            "state": "MO",
            "postal_code": "653251240",
            "telephone_number": "660-668-0155",
            "fax_number": "660-668-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E MAIN ST",
            "city": "COLE CAMP",
            "state": "MO",
            "postal_code": "653251240",
            "telephone_number": "660-668-0155",
            "fax_number": "660-668-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "SHANDA",
        "middle_name": "LEANN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2012-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MO",
            "license": "2012003674",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012003674",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2012003674",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MO",
            "license": "2012003674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Danielle Schirding, MD
• Michael Scott Snell, R.PH
• Summers Pharmacy No 9, LLC Dba Summers Pharmacy of Cole Camp (Cole Camp Pharmacy)
• Misty Faye Todd, M.D.
• Amy Vandaveer, COTA
• Eric Stanley Wilson, DDS

• Clinical Social Worker in Cole Camp, MO
• Providers in Cole Camp, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; 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.