Individual
BARRY SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5012
Mailing address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5012
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/22/2020
Last updated
11/28/2022
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