Individual
CARLIE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
736 FEDERAL ST., STE. 1-103, DAVENPORT, IA 52803-5768
(309) 684-3212
Mailing address
736 FEDERAL ST., STE. 1-103, DAVENPORT, IA 52803-5768
(309) 684-3212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
091279
IA
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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