Individual
SHANNON MICHELLE WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT, CNMT
Contact information
Practice address
5180 N UNION BLVD # 209, COLORADO SPRINGS, CO 80918-2000
(719) 351-1551
Mailing address
919 RANCHER DR, FOUNTAIN, CO 80817-4113
(719) 351-1551
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0023537
CO
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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