Provider Demographics
NPI:1053702043
Name:WALSDORF, SHANNON (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:WALSDORF
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 AZALEA CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7044
Mailing Address - Country:US
Mailing Address - Phone:985-373-8609
Mailing Address - Fax:
Practice Address - Street 1:4005 AZALEA CT
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7044
Practice Address - Country:US
Practice Address - Phone:985-373-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA112021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical