Individual
SHANNON MOONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BEHAVIOR SPECIALIST
Contact information
Practice address
376 5TH ST, IDAHO FALLS, ID 83401-4762
(208) 403-1559
Mailing address
376 5TH ST, IDAHO FALLS, ID 83401-4762
(208) 403-1559
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
07/20/2019
Last updated
07/20/2019
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