Individual
DAVIS SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
702 W CHESTNUT ST, BLOOMINGTON, IL 61701-2814
(217) 649-5765
Mailing address
702 W CHESTNUT ST, BLOOMINGTON, IL 61701-2814
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IL
Other
Enumeration date
07/27/2016
Last updated
04/17/2026
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