Provider Demographics
NPI:1124269527
Name:SHAWVER, DIAN (LMSW)
Entity type:Individual
Prefix:
First Name:DIAN
Middle Name:
Last Name:SHAWVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 YELLOWSTONE AVE
Mailing Address - Street 2:STE J
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4478
Mailing Address - Country:US
Mailing Address - Phone:208-478-9551
Mailing Address - Fax:208-478-1507
Practice Address - Street 1:1023 YELLOWSTONE AVE
Practice Address - Street 2:STE J
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4478
Practice Address - Country:US
Practice Address - Phone:208-478-9551
Practice Address - Fax:208-478-1507
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-273621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical