Individual
MARIE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
909 W MAIN ST, SUITE 1, MANCHESTER, IA 52057-1522
(563) 927-5112
Mailing address
514 E PROSPECT ST, MANCHESTER, IA 52057-1404
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
99055
IA
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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