Individual
SHANNON NICHOLE MODJESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
816 W 10TH ST, MEDFORD, OR 97501-3016
(541) 734-5437
(541) 734-2425
Mailing address
816 W 10TH ST, MEDFORD, OR 97501-3016
(541) 734-5437
(541) 734-2425
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC14009
AZ
Other
Enumeration date
10/26/2012
Last updated
06/01/2016
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