Individual
JESSICA B SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1092 DUVAL ST STE 230, LEXINGTON, KY 40515-8908
(859) 539-0312
Mailing address
1092 DUVAL ST STE 230, LEXINGTON, KY 40515-8908
(859) 338-0466
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
4019
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
05
—
7100352950
—
KY
Enumeration date
07/15/2010
Last updated
07/20/2024
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