Shannon Mandle Kettner in Colorado Springs - Clinical
Shannon Mandle Kettner - NPI 1609933449
Shannon Mandle Kettner is a Clinical in Colorado Springs, Colorado. Shannon Mandle Kettner practices all healthcare services and medical treatments related to Clinical. The NPI Number for Shannon Mandle Kettner is 1609933449. The last update date is 2015-11-17.
Shannon Mandle Kettner's current location address is 3141 Centennial Blvd, Colorado Springs, Colorado. You can contact this provider via phone number 7193275660. The mailing address for Shannon Mandle Kettner is 3141 Centennial Blvd, Colorado Springs, Colorado. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Shannon Mandle Kettner |
|---|---|
| Address | 3141 Centennial Blvd, Colorado Springs, Colorado |
| Phone Number | 7193275660 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | PHD, LSCSW |
NPI Number Detail
| NPI Number | 1609933449 |
|---|---|
| Provider Enumeration Date | 2007-01-02 |
| Last Updated Date | 2015-11-17 |
Provider Mailing Address Detail
| Address | 3141 Centennial Blvd |
|---|---|
| City | Colorado Springs |
| State | Colorado (CO) |
| Post Code | 809074094 |
| Phone Number | 7193275660 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 1075 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique 10-digit identification code assigned to Shannon Mandle Kettner by the Centers for Medicare & Medicaid Services?
The Shannon Mandle Kettner has been issued the NPI (National Provider Identifier) 1609933449, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Shannon Mandle Kettner is located?
The Shannon Mandle Kettner is situated at the following address: 3141 Centennial Blvd, Colorado Springs, CO, 809074094.
What is Shannon Mandle Kettner's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Shannon Mandle Kettner's specialized field of practice is Clinical, and the corresponding taxonomy code that categorizes this area of specialization is 1041C0700X.
On what date did the Shannon Mandle Kettner receive the assignment of its 1609933449 from the Centers for Medicare & Medicaid Services?
The Shannon Mandle Kettner was issued its 1609933449 by the Centers for Medicare & Medicaid Services on 2007-01-02.
As of what date were the Shannon Mandle Kettner's details last updated?
The information pertaining to the Shannon Mandle Kettner, including its address, specialty, and other details, was most recently updated on 2015-11-17.
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