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General NPI Number Information
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NPI Number | 1366092306
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Entity Type | Individual
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Provider Name | SHAWNA ROEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 3640 HIGHWAY 95 STE 120
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-4336
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Country | US
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Telephone | 928-900-4748
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Fax | 928-420-8950
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Provider Business Mailing Address
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Address Line | 1959 E DESERT DR
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-8802
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Country | US
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Telephone | 928-862-8689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-19912
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19112
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License Number State | AZ
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