Individual
DR. SHANNON P DARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3550 S NATIONAL AVE, SUITE 200, SPRINGFIELD, MO 65807-7309
(417) 269-9300
Mailing address
3550 S NATIONAL AVE, SUITE 200, SPRINGFIELD, MO 65807-7309
(417) 269-9300
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2008009364
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00859517
RAILROAD MEDICARE
—
Enumeration date
04/20/2009
Last updated
11/19/2010
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