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Individual

JACQUALYN D SHANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
325 AUDLEY AVE APT 4, BOWLING GREEN, KY 42101-4489
(615) 423-5017
Mailing address
325 AUDLEY AVE APT 4, BOWLING GREEN, KY 42101-4489
(615) 423-5017

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
201237255
KY

Other

Enumeration date
02/05/2025
Last updated
02/05/2025
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