Healthcare Provider Details

I. General information

NPI: 1528007192
Provider Name (Legal Business Name): ANDREA M SHOOK MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N. ENGLEWOOD DRIVE
CRAWFORDSVILLE IN
47933
US

IV. Provider business mailing address

110 N FRENCH ST
SULLIVAN IN
47882-1424
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-9767
  • Fax: 765-361-0374
Mailing address:
  • Phone: 812-268-4805
  • Fax: 812-242-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003254A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: