Provider Demographics
NPI:1487796496
Name:THORNTON, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5000 W 108TH ST
Mailing Address - Street 2:1412
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1282
Mailing Address - Country:US
Mailing Address - Phone:937-422-6176
Mailing Address - Fax:
Practice Address - Street 1:421 E 137TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1455
Practice Address - Country:US
Practice Address - Phone:816-508-3621
Practice Address - Fax:816-508-3797
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100225001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200471260Medicaid
IN200471260Medicaid