Provider Demographics
NPI:1538165154
Name:SHADOIN, JOHANNA CHOATE (LCSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:CHOATE
Last Name:SHADOIN
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 1:1410 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2804
Mailing Address - Country:US
Mailing Address - Phone:615-297-6630
Mailing Address - Fax:615-297-8228
Practice Address - Street 1:1410 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2804
Practice Address - Country:US
Practice Address - Phone:615-297-6630
Practice Address - Fax:615-297-8228
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522905Medicaid
TN36950831Medicare PIN