Provider Demographics
NPI:1770732356
Name:LANDAZURI, SHAWNA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:LANDAZURI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 W REPUBLIC RD STE F100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5810
Mailing Address - Country:US
Mailing Address - Phone:417-866-7773
Mailing Address - Fax:417-866-7792
Practice Address - Street 1:636 W REPUBLIC RD STE F100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5810
Practice Address - Country:US
Practice Address - Phone:417-866-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180385981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical