Healthcare Provider Details

I. General information

NPI: 1619887957
Provider Name (Legal Business Name): SHAWNA HEATH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GOVERNMENT WAY STE 300
COEUR D ALENE ID
83814-2976
US

IV. Provider business mailing address

500 N GOVERNMENT WAY STE 300
COEUR D ALENE ID
83814-2976
US

V. Phone/Fax

Practice location:
  • Phone: 208-273-9147
  • Fax:
Mailing address:
  • Phone: 208-273-9147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5381411
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: