Doctor Name: | SHAWNA PLUNKETT |
NPI Number: | 1245621432 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 20042831A |
Business Practice Address: | 411 S Whitlock St Bremen, IN - 465061626 |
Business Phone Number: | 5745461900 |
Business Fax Number: | 5745461999 |
Mailing Address: | 411 S Whitlock St, BREMEN |
State: | IN |
Postal Code: | 465061626 |
Phone Number: | 5745461900 |
Fax Number: | 5745461999 |
NPI Enumeration Date: | 02/10/2015 |
NPI Last Update Date: | 02/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 20042831A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |