Healthcare Provider Details

I. General information

NPI: 1285647651
Provider Name (Legal Business Name): SHIRLEY SLOAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOMESTEAD RD #55
LEHIGH ACRES FL
33936-6049
US

IV. Provider business mailing address

PO BOX 487
IMMOKALEE FL
34143-0487
US

V. Phone/Fax

Practice location:
  • Phone: 239-281-8903
  • Fax: 239-657-2308
Mailing address:
  • Phone: 239-281-8903
  • Fax: 239-657-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: