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General NPI Number Information
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NPI Number | 1407109408
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Entity Type | Individual
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Provider Name | SHANNON MARIE KROENKE MSW, LCSW, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 101 E 8TH ST STE 110
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City | VANCOUVER
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State | WA
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Zip | 98660-3294
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Country | US
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Telephone | 360-524-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E 8TH ST STE 110
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City | VANCOUVER
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State | WA
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Zip | 98660-3294
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Country | US
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Telephone | 360-524-2126
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Fax | 360-953-8533
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60887254
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | LW60887254
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LW60887254
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License Number State | WA
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