Individual
KRISTEN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1443 CORPORATE WAY, SEYMOUR, IN 47274-3391
(812) 522-4341
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34009064A
IN
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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