Individual
SHANNON GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 W. 200 N., MONA, UT 84648
(435) 623-2825
(435) 623-2827
Mailing address
619 N 500 W, PROVO, UT 84601-1547
(801) 375-4240
(801) 375-4241
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/14/2011
Last updated
02/14/2011
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