Individual
SHANNON R MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
17505 N 79TH AVE STE 304A, GLENDALE, AZ 85308-8729
(623) 606-5522
(623) 878-5800
Mailing address
7558 W THUNDERBIRD RD STE 1-492, PEORIA, AZ 85381-6080
(623) 606-5522
(623) 878-5800
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-13585
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
709592
—
AZ
Enumeration date
01/27/2011
Last updated
07/16/2021
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