Individual
SHANNON RAE PIPPIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5512 37TH AVE E, BRADENTON, FL 34208-6825
(352) 209-6884
Mailing address
5512 37TH AVE E, BRADENTON, FL 34208-6825
(352) 209-6884
(941) 487-5430
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000471100
—
FL
05
—
006703300
—
FL
Enumeration date
09/05/2008
Last updated
08/29/2014
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