Provider Demographics
NPI:1174070643
Name:WALLIN, SHENEA
Entity type:Individual
Prefix:
First Name:SHENEA
Middle Name:
Last Name:WALLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4047
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-4047
Mailing Address - Country:US
Mailing Address - Phone:606-492-7661
Mailing Address - Fax:
Practice Address - Street 1:3110 OLD BULL RD
Practice Address - Street 2:
Practice Address - City:EUBANK
Practice Address - State:KY
Practice Address - Zip Code:42567-7773
Practice Address - Country:US
Practice Address - Phone:606-492-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker