Individual
SHANTILL LYNN MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1060 WEBBER ST, THE DALLES, OR 97058-3749
(541) 296-5452
Mailing address
1211 MURRAY DR W, THE DALLES, OR 97058-4610
(541) 288-4852
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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