David W. Shane, L.C.S.W. (ILLINOIS)

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.002871 Issued in IL

Practice address

512 S Fremont St
Orchard Corners 150-160
Shenandoah, IA 51601-1508

Phone

(712) 246-0092

NPI assigned

Apr 8, 2009

Sex

Male

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": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239148800000",
    "number": "1811130792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 S FREMONT ST",
            "address_2": "ORCHARD CORNERS 150-160",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516011508",
            "telephone_number": "712-246-0092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 S FREMONT ST",
            "address_2": "ORCHARD CORNERS 150-160",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516011508",
            "telephone_number": "712-246-0092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANE",
        "first_name": "DAVID",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "L.C.S.W. (ILLINOIS)",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2009-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.002871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Andrew Rozeboom, M.D.
• Michael Theodore Salwitz, MD
• Rebecca Ann Schaeffer, RN
• John Schleef, D.C.
• Alicia Pearl Schroder, PHARMD
• Shenandoah Ambulance Service
• Shenandoah Care Center, LLC
• Shenandoah Community School District
• Shenandoah Doctors Clinic
• Shenandoah Enterprises LLC

• Clinical Social Worker in Shenandoah, IA
• Providers in Shenandoah, IA by specialty
• Clinical Social Worker in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; 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.