Individual
INGRID L SHADOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3540 MANDERLY PL, FORT WORTH, TX 76109-4520
(817) 739-8170
Mailing address
3540 MANDERLY PL, FORT WORTH, TX 76109-4520
(817) 739-8170
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
35298
TX
Other
Enumeration date
03/22/2024
Last updated
03/22/2024
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