| Doctor Name: | LOANNE M SHACKELFORD |
| NPI Number: | 1902847759 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW LCSW |
| License Number: | 991075 |
| Business Practice Address: | 200 S. Main St. La Veta, CO - 810550148 |
| Business Phone Number: | 7197423372 |
| Business Fax Number: | 7197423373 |
| Mailing Address: | Po Box 148, LA VETA |
| State: | CO |
| Postal Code: | 810550148 |
| Phone Number: | 7197423372 |
| Fax Number: | 7197423373 |
| NPI Enumeration Date: | 06/10/2006 |
| NPI Last Update Date: | 11/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 991075 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |