Individual
SHAWNDELL KAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2820 HINKLE LAKE RD, BRIDGEPORT, WV 26330-6783
(304) 476-8582
Mailing address
2820 HINKLE LAKE RD, BRIDGEPORT, WV 26330-6783
(304) 476-8582
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/07/2024
Last updated
11/07/2024
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