Individual
SHANNON REITAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
144 DUCK SOUP LN, FRIDAY HARBOR, WA 98250-6735
(360) 378-2669
(360) 378-5669
Mailing address
144 DUCK SOUP LN, FRIDAY HARBOR, WA 98250-6735
(360) 378-2669
(360) 378-5669
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60629779
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60629779
WASHINGTON STATE LICENSE NUMBER
WA
Enumeration date
01/30/2017
Last updated
01/30/2017
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