Individual
SHANNON O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
444 HOSPITAL WAY, STE 477, POCATELLO, ID 83201-2745
(208) 233-7832
(208) 233-7835
Mailing address
444 HOSPITAL WAY, STE 477, POCATELLO, ID 83201-2745
(208) 233-7832
(208) 233-7835
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/18/2015
Last updated
11/18/2015
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