Healthcare Provider Details

I. General information

NPI: 1336916014
Provider Name (Legal Business Name): SHANNON K SLINKEY LMSW/LMSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SANDY SPRINGS RD
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 2445
GALLUP NM
87305-2445
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5511
  • Fax:
Mailing address:
  • Phone: 505-726-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2022-0853
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: