Individual
SHANNON MARIE NORTHUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 W FRANKLIN ST STE A, SHELTON, WA 98584-3518
(360) 462-3016
Mailing address
601 W FRANKLIN ST STE A, SHELTON, WA 98584-3518
(360) 462-3016
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/13/2019
Last updated
08/03/2022
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