Provider Demographics
NPI:1124458765
Name:SHADLE, ERIN ALEXIS (MA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ALEXIS
Last Name:SHADLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10544 DALTON RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-9738
Mailing Address - Country:US
Mailing Address - Phone:765-969-8164
Mailing Address - Fax:
Practice Address - Street 1:10544 DALTON RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-9738
Practice Address - Country:US
Practice Address - Phone:765-969-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health