Individual
ALEXANDRIA NICOLE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2210 MAIN DR, SPRINGDALE, AR 72762-6802
(479) 856-6397
(479) 856-6412
Mailing address
PO BOX 130, ROGERS, AR 72757-0130
(479) 856-6397
(479) 856-6412
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/10/2022
Last updated
11/10/2022
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