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General NPI Number Information
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NPI Number | 1508016932
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Entity Type | Individual
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Provider Name | SHANNON KAY DURHAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 1620 HILLTOP DR
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City | WARSAW
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State | MO
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Zip | 65355-3057
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Country | US
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Telephone | 660-428-1280
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Fax | 660-428-1283
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Provider Business Mailing Address
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Address Line | 1800 COMMUNITY
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City | CLINTON
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State | MO
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Zip | 64735-8804
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Country | US
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Telephone | 660-885-8186
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2008009872
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License Number State | MO
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