Individual
SHANNON TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
875 S SHERIDAN AVE, SHERIDAN, WY 82801-5244
(307) 751-4695
Mailing address
875 S SHERIDAN AVE, SHERIDAN, WY 82801-5244
(307) 751-4695
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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