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Individual
SHANNON M WEISE
Active
Individual
SHANNON M WEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW016016
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100775933
—
PA
Enumeration date
04/06/2007
Last updated
03/17/2018
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