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General NPI Number Information
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NPI Number | 1932539681
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Entity Type | Individual
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Provider Name | NORDIA SHACKELFORD LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/16/2013
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 3272 CALIFORNIA AVE SW STE 300
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City | SEATTLE
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State | WA
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Zip | 98116-3375
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Country | US
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Telephone | 206-289-0438
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Fax |
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Provider Business Mailing Address
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Address Line | 3272 CALIFORNIA AVE SW STE 300
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City | SEATTLE
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State | WA
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Zip | 98116-3375
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Country | US
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Telephone |
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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 | 0904008972
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License Number State | VA
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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 | 077840
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60765277
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License Number State | WA
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