Individual
SHAWN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
68470 S 315 RD, WAGONER, OK 74467-6292
(918) 729-9397
(918) 482-5136
Mailing address
68470 S 315 RD, WAGONER, OK 74467-6292
(918) 729-9397
(918) 482-5136
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/03/2014
Last updated
01/03/2014
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