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Individual
MRS. SHANDA LEANN WATSON
Active
Individual
MRS. SHANDA LEANN WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
2012003674
MO
104100000X
Social Worker
2012003674
MO
1041C0700X
Clinical Social Worker
Primary
2012003674
MO
1041S0200X
School Social Worker
2012003674
MO
Other
Enumeration date
06/07/2011
Last updated
02/13/2012
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