Individual
SHANNON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 COLUMBIA LN, PROVO, UT 84604-1320
(801) 375-4240
Mailing address
619 N 500 W, PROVO, UT 84601-1547
(801) 375-4240
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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