Provider Demographics
NPI:1871473744
Name:ATWOOD, SHAWN CAMERON (MASTERS OF EDUCATION)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:CAMERON
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:MASTERS OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E 17TH ST STE 355
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6453
Mailing Address - Country:US
Mailing Address - Phone:208-497-0685
Mailing Address - Fax:
Practice Address - Street 1:1820 E 17TH ST STE 330
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6400
Practice Address - Country:US
Practice Address - Phone:208-497-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician