Provider Demographics
NPI:1548551955
Name:FERGUSON, SHAUNDAWNA NICOLE (BA CIT)
Entity type:Individual
Prefix:
First Name:SHAUNDAWNA
Middle Name:NICOLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:BA CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 N CHRYSLER DR
Mailing Address - Street 2:#3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4871
Mailing Address - Country:US
Mailing Address - Phone:479-530-1117
Mailing Address - Fax:
Practice Address - Street 1:1200 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3521
Practice Address - Country:US
Practice Address - Phone:479-636-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)