Individual
HEATHER L SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
803 S MAIN ST STE 120, MOSCOW, ID 83843-2695
(208) 848-8300
Mailing address
130 SPRUCE ST, POTLATCH, ID 83855-5006
(714) 625-5546
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-39251
ID
104100000X
Social Worker
Primary
SC61643330
WA
Other
Enumeration date
07/31/2023
Last updated
04/25/2025
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