Individual
MRS. SHANNON T. LICANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4449 N 12TH ST, PHOENIX, AZ 85014-4520
(602) 279-1427
Mailing address
PO BOX 16906, PHOENIX, AZ 85011-6906
(602) 279-1427
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
AZ
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
04/02/2007
Last updated
07/09/2014
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