# SHAWNENE JAYNE NICKERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1093022527
- **Gender:** F
- **Credential:** LCSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | CERTIF 10089 REF 743 | ID | — |
| 104100000X | Social Worker | LMSW-24582 | ID | — |
| 1041C0700X | Clinical Social Worker | LCSW31784 | ID | Yes |
| 1041C0700X | Clinical Social Worker | LICSW 1433 | NE | — |
| 1041C0700X | Clinical Social Worker | LIMHP 964 | NE | — |
| 1041S0200X | School Social Worker | IDAHO | ID | — |
| 1041S0200X | School Social Worker | LMSW-24582 | ID | — |

## Other

- **Enumeration date:** 09/03/2010
- **Last updated:** 11/01/2012