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Individual

SHANNON KAY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 522-0140
(208) 522-0141
Mailing address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 522-0140
(208) 522-0141

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-36196
ID

Other

Enumeration date
11/08/2016
Last updated
11/08/2016
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