Individual
SHANNON LEE HEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 MONTE VISTA DR., CASPER, WY 82601
(307) 472-1762
Mailing address
3415 MONTE VISTA DR., CASPER, WY 82601
(307) 472-1762
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/01/2009
Last updated
10/01/2009
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