Provider Demographics
NPI:1427338581
Name:WEAVER, SHANNON HEATHER (CADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:HEATHER
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 SULLIVAN SLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9013
Mailing Address - Country:US
Mailing Address - Phone:319-753-0700
Mailing Address - Fax:319-754-7885
Practice Address - Street 1:4715 SULLIVAN SLOUGH RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9013
Practice Address - Country:US
Practice Address - Phone:319-753-0700
Practice Address - Fax:319-754-7885
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11025101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)