Individual
SHANNON ONTIVEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
406 W KOENIG ST, GRAND ISLAND, NE 68801-6516
(308) 675-3345
(308) 675-3342
Mailing address
707 W 1ST ST, GRAND ISLAND, NE 68801-5805
(308) 675-3345
(308) 675-3342
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-2280
NE
Other
Enumeration date
08/07/2024
Last updated
05/01/2025
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