Individual
MADISON ELISSA CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 676-2253
Mailing address
9100 W 74TH ST, SHAWNEE MISSION, KS 66204-4004
(913) 676-2253
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
21-165129
KS
Other
Enumeration date
05/04/2021
Last updated
05/04/2021
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