Provider Demographics
NPI:1285878025
Name:WALISER, SHANNON KRISTI (MSW, MPA, LICSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:KRISTI
Last Name:WALISER
Suffix:
Gender:F
Credentials:MSW, MPA, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1286
Mailing Address - Country:US
Mailing Address - Phone:304-363-4265
Mailing Address - Fax:
Practice Address - Street 1:295 HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5449
Practice Address - Country:US
Practice Address - Phone:304-363-4265
Practice Address - Fax:304-999-4826
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009425211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical