Provider Demographics
NPI:1992885156
Name:HANKS, SHELLEY S (MSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:S
Last Name:HANKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:S
Other - Last Name:CUTSFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33600 6TH AVE S
Mailing Address - Street 2:STE. 212
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6743
Mailing Address - Country:US
Mailing Address - Phone:253-661-0181
Mailing Address - Fax:253-661-9190
Practice Address - Street 1:33600 6TH AVE S
Practice Address - Street 2:STE. 212
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6743
Practice Address - Country:US
Practice Address - Phone:253-661-0181
Practice Address - Fax:253-661-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
217000824Medicare ID - Type Unspecified