Shannon Lee Baker-Spoor, LICSW
Individual provider Active NPI Clinical Social Worker · Lake Tapps, WA
NPI 1366745606 · NPPES record last updated Dec 8, 2010
Key facts
- NPI
- 1366745606
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LW00007257 (WA)
- Practice address
- 3210 Deer Island Dr E
Lake Tapps, WA 98391-9492 - Phone
- (253) 350-9708
- NPI assigned
- Dec 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW00007257 | WA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW00007257 | WA | Yes |
Addresses
Primary practice location
3210 Deer Island Dr E
Lake Tapps, WA 98391-9492
Mailing address
3210 Deer Island Dr E
Lake Tapps, WA 98391-9492
Phone (253) 350-9708
Other providers in Lake Tapps, WA
All providers in Lake Tapps, WA · Clinical Social Worker in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.