Provider Demographics
NPI:1962748004
Name:KAIB, SHANNON JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:KAIB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115B WHITETAIL LN
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-0267
Mailing Address - Country:US
Mailing Address - Phone:724-332-3299
Mailing Address - Fax:
Practice Address - Street 1:162 BRICKYARD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-3067
Practice Address - Country:US
Practice Address - Phone:724-332-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical