Individual
SHANNON ALYS ITJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 US HIGHWAY 46 W STE 100, HASBROUCK HEIGHTS, NJ 07604-3120
(201) 478-4175
Mailing address
611 US HIGHWAY 46 W STE 100, HASBROUCK HEIGHTS, NJ 07604-3120
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06535000
NJ
Other
Enumeration date
11/11/2022
Last updated
11/11/2022
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