Basic Information
| Provider Information | |||||||||
| NPI: | 1750706909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOVLAIN | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3370 E HARBOR DR | ||||||||
| Address2: | |||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527225502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5636500244 | ||||||||
| FaxNumber: | 5633550101 | ||||||||
| Practice Location | |||||||||
| Address1: | 2322 E KIMBERLY RD | ||||||||
| Address2: | SUITE 200 NORTH | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528077205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633550055 | ||||||||
| FaxNumber: | 5633550101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2014 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 09031 | IA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.