Shawna Roen, LCSW – Clinical Social Worker

Key facts

NPI: 1366092306
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: 19112 (AZ)
Practice address: 3640 Highway 95 Ste 120
Bullhead City, AZ 86442-4336
Phone: (928) 900-4748
Fax: (928) 420-8950
NPI assigned: Sep 11, 2019
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Mindcheck Inc. Clinical Social Worker · Bullhead City, AZ · NPI 1134908015

Medicare reassignment NPD Authorized official AZ · CLINICAL

Medicare Care Compare profile

Specialty: Clinical Social Worker
Education: Other, 2011
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3640 Hwy 95
Suite 120
Bullhead City, AZ 86442-4336
Phone (928) 900-4748

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AZ
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20251015002136	AZ	Practitioner - Clinical Social Worker	2466949268	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
19112	AZ	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Mindcheck Inc.	Clinical	Current since Jul 14, 2025	Accepting new patients

Locations

3640 Highway 95
Ste 120
Bullhead City, AZ 86442
Phone (928) 862-8689

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	LCSW-19912
Clinical Social Worker	1041C0700X	19112	AZ	Yes

Addresses

Primary practice location

3640 Highway 95 Ste 120
Bullhead City, AZ 86442-4336

Mailing address

1959 E Desert Dr
Fort Mohave, AZ 86426-8802
Phone (928) 862-8689

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 20, 2025.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1366092306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 E DESERT DR",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864268802",
            "telephone_number": "928-862-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 HIGHWAY 95 STE 120",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864424336",
            "telephone_number": "928-900-4748",
            "fax_number": "928-420-8950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEN",
        "first_name": "SHAWNA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-11",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "LCSW-19912",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "19112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullhead City, AZ

All providers in Bullhead City, AZ · Clinical Social Worker in Arizona

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.