Shannon Darell Wade

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

IMF96917 Issued in CA

Practice address

24077 State Highway 49
Nevada City, CA 95959-8519

Phone

(530) 265-9057

NPI assigned

Aug 2, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Shannon Darell Hogan Former name

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": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1568915981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4416 NORWOOD AVE APT 74",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958382262",
            "telephone_number": "916-420-4803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24077 STATE HIGHWAY 49",
            "city": "NEVADA CITY",
            "state": "CA",
            "postal_code": "959598519",
            "telephone_number": "530-265-9057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 D St",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "CA",
            "postal_code": "959016017",
            "country_code": "US",
            "telephone_number": "530-671-3427 x1135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "SHANNON",
        "middle_name": "DARELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF96917",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "HOGAN",
            "middle_name": "DARELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chantelle M Vaughan, PT
• Andrea L Viehmann
• Gregory E Vixie, DDS
• Gregory Max Vogt, PH.D.
• Noelle F Voorhees, M.S., PPSC, LMFT
• Patrick Owen Wagner, MD
• Fidha Waheed
• Gail Yon Walls
• Kathleen Judith Walsh, M.A.
• Maya Waterstar, AMFT

• Marriage & Family Therapist in Nevada City, CA
• Providers in Nevada City, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.