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Provider Information for 1558009902


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SAVANNA SHACKELFORD LICSW


Sex: Female

NPI: 1558009902
Last Updated: 2022-05-25
Certification Date: 2022-05-25

Details

NameValue
NPI1558009902
Enumeration Date2022-05-25
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 713 COVINGTON AVE
BIRMINGHAM, AL 35206-3012
United States

Phone: | Fax:
 
Primary Practice Address 1401 20TH ST S
BIRMINGHAM, AL 35205-4913
United States

Phone: 205-580-3014 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalAL5043C