Individual
SHANNON BRODALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8253 W THUNDERBIRD RD, #103, PEORIA, AZ 85381-4616
(623) 826-0932
(623) 776-9921
Mailing address
8253 W THUNDERBIRD RD, #103, PEORIA, AZ 85381-4616
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1457349037
AZ
Other
Enumeration date
08/04/2006
Last updated
07/08/2007
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