MEDICARE: SHAWNA SUE GULICK MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2011014618	MO

General Provider Information

NPI Number	:	1891841300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA SUE GULICK MSW, LCSW

Provider Business Mailing Address
First Line	:	5642 S 244TH RD
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-9119
Country	:	US
Telephone Number	:	417-224-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	5642 S 244TH RD
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-9119
Country	:	US
Telephone Number	:	417-224-0933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/03/2023

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