Provider Demographics
NPI:1245723774
Name:SHANKS, ZOWEE
Entity type:Individual
Prefix:
First Name:ZOWEE
Middle Name:
Last Name:SHANKS
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 1:24 WEATHERFORD SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2202
Mailing Address - Country:US
Mailing Address - Phone:773-660-6766
Mailing Address - Fax:
Practice Address - Street 1:24 WEATHERFORD SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2202
Practice Address - Country:US
Practice Address - Phone:773-660-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health