Provider Demographics
NPI:1366798464
Name:CIGANICK, SHANDA KATHERINE
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:KATHERINE
Last Name:CIGANICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:KATHERINE
Other - Last Name:SLAGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSAT
Mailing Address - Street 1:10444 E BILLINGS ST
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-4240
Mailing Address - Country:US
Mailing Address - Phone:480-734-0199
Mailing Address - Fax:
Practice Address - Street 1:10444 E BILLINGS ST
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-4240
Practice Address - Country:US
Practice Address - Phone:480-734-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLSAT 12049101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)