Individual
KATIE B SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2224 1ST AVE W STE 4, WILLISTON, ND 58801-6286
(701) 572-3335
Mailing address
2224 1ST AVE W STE 4, WILLISTON, ND 58801-6286
(701) 572-3335
(701) 572-3337
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3671
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27774
BLUE CROSS BLUE SHIELD
ND
05
—
54516
—
ND
Enumeration date
02/27/2007
Last updated
01/11/2022
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