Provider Demographics
NPI:1124838933
Name:LOTT, SHANNA (LSW)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-1816
Mailing Address - Country:US
Mailing Address - Phone:765-271-6560
Mailing Address - Fax:317-469-1674
Practice Address - Street 1:1234 N COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-2754
Practice Address - Country:US
Practice Address - Phone:765-860-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011874A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker