Individual
MRS. SHANNON M NILEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LPP
Contact information
Practice address
4710 CHAMPIONS TRACE LN, SUITE 107, LOUISVILLE, KY 40218-3495
(502) 454-6353
(502) 459-9209
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
(502) 589-8600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
114308
KY
Other
Enumeration date
06/21/2007
Last updated
06/06/2016
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