Healthcare Provider Details

I. General information

NPI: 1740332063
Provider Name (Legal Business Name): SHAWNA D WRIGHT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SOUTH KANSAS
CHANUTE KS
66720
US

IV. Provider business mailing address

PO BOX 335 402 SOUTH KANSAS
CHANUTE KS
66720
US

V. Phone/Fax

Practice location:
  • Phone: 620-431-7890
  • Fax: 620-431-7927
Mailing address:
  • Phone: 620-431-7890
  • Fax: 620-431-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1236
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP1236
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberLP1236
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1236
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: