Provider Demographics
NPI:1144095209
Name:HEARNE, SHANNON CASSIDY
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CASSIDY
Last Name:HEARNE
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 1:2611 CASTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2017
Mailing Address - Country:US
Mailing Address - Phone:219-713-0246
Mailing Address - Fax:
Practice Address - Street 1:2611 CASTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2017
Practice Address - Country:US
Practice Address - Phone:219-713-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL886866811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker