Individual
SHAWN GABRIEL TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
166 N 5TH W APT E3, REXBURG, ID 83440-1449
(801) 735-5457
Mailing address
166 N 5TH W APT E3, REXBURG, ID 83440-1449
(801) 735-5457
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
ID
Other
Enumeration date
01/24/2023
Last updated
01/24/2023
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