Individual
BENJAMIN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA, EXP
Contact information
Practice address
3261 COLONY VISTA LN, COLUMBUS, OH 43204-2157
(614) 859-9584
Mailing address
3261 COLONY VISTA LN, COLUMBUS, OH 43204-2157
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
SM594493
OH
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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