Individual
SHANNON BAZAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
650 OFFICE PKWY, SAINT LOUIS, MO 63141-7103
(314) 650-0206
Mailing address
9 HORSESHOE CT, WRIGHT CITY, MO 63390-3725
(314) 650-0206
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2019044273
MO
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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