Individual
JONATHAN SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
813 CAPITOL ST, SPENCER, WV 25276-1924
(304) 485-6513
Mailing address
2507 9TH AVE, PARKERSBURG, WV 26101-5855
(304) 485-6513
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
A1W134600190
WV
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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