Provider Demographics
NPI:1558255695
Name:KNIGHT, SHANNEN IDALENE
Entity type:Individual
Prefix:MRS
First Name:SHANNEN
Middle Name:IDALENE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANNEN
Other - Middle Name:IDALENE
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3135 97TH PL APT 23
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3903
Mailing Address - Country:US
Mailing Address - Phone:219-298-5242
Mailing Address - Fax:
Practice Address - Street 1:10419 CALUMET AVE STE B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4059
Practice Address - Country:US
Practice Address - Phone:219-301-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-337352106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician