Shauna A Wasden, LMSW
Individual provider Active NPI Social Worker · Saint Anthony, ID
NPI 1932937802 · NPPES record last updated Aug 9, 2024
Key facts
- NPI
- 1932937802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- LMSW-45236 (ID)
- Practice address
- 335 E Main St Ste 3
Saint Anthony, ID 83445-1546 - Phone
- (208) 356-4900
- Fax
- (208) 624-4030
- NPI assigned
- Jul 23, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-45236 | ID | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Valley Community Health Services Inc | Social Worker | Past | Accepting new patients |
| Upper Valley Community Health Services Inc | Social Worker | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW-45236 | ID | Yes |
Addresses
Primary practice location
335 E Main St Ste 3
Saint Anthony, ID 83445-1546
Mailing address
PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900
Other practice location 1
72 S 1st E Ste 103
Rexburg, ID 83440-1965
Phone (208) 356-4900
Other providers in Saint Anthony, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2024. 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.