Individual
SHANNON DEE WASSAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 E SMITH ST, SMITHTON, MO 65350-1079
(660) 343-3681
(660) 343-5871
Mailing address
PO BOX 513, 308 E SMITH, SMITHTON, MO 65350-0513
(660) 343-3681
(660) 343-5871
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/19/2007
Last updated
10/07/2014
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