Provider Demographics
NPI:1346619202
Name:SHOEMAKE, KRISTEN T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:T
Last Name:SHOEMAKE
Suffix:
Gender:F
Credentials:LCSW
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 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-1310
Practice Address - Street 1:3619 HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748-6237
Practice Address - Country:US
Practice Address - Phone:225-683-1360
Practice Address - Fax:225-634-0005
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X, 171M00000X
LA118151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator