Individual
MRS. SHANNON STANUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EIS
Contact information
Practice address
19965 FM 3175, LYTLE, TX 78052-3481
(210) 357-0395
(830) 709-5493
Mailing address
PO BOX 725, LYTLE, TX 78052-0725
(210) 357-0395
(830) 709-5493
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
093738
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-3738
LICENSE OTHER
TX
Enumeration date
11/10/2010
Last updated
11/10/2010
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