Individual
MS. SHASTA LYNN EDMONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 S MOUNT JULIET RD STE 235-118, MT JULIET, TN 37122-6359
(703) 506-0123
Mailing address
938 TINY TOWN RD, CLARKSVILLE, TN 37042-4602
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
01/16/2023
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