Individual
LAURA HILLARY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(715) 829-5195
Mailing address
PO BOX 11231, JACKSON, WY 83002-1231
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-35408
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/29/2018
Last updated
01/06/2020
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