Healthcare Provider Details

I. General information

NPI: 1093202897
Provider Name (Legal Business Name): SHAWNA MARIE HIGLE CAODC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE
CERES CA
95307-4562
US

IV. Provider business mailing address

2401 DENNY CT
CERES CA
95307-3134
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7441
  • Fax:
Mailing address:
  • Phone: 209-809-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: