Individual
HEATHER L SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LSWAIC
Contact information
Practice address
803 S MAIN ST STE 201, MOSCOW, ID 83843-2695
(208) 848-8300
Mailing address
803 S MAIN ST STE 201, MOSCOW, ID 83843-2695
(208) 683-8320
(509) 444-7806
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW-8861257
ID
104100000X
Social Worker
LMSW-39251
ID
104100000X
Social Worker
SC61643330
WA
Other
Enumeration date
07/31/2023
Last updated
08/12/2026
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