Individual
SHANNON MCKAY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NA
Contact information
Practice address
3526 WYOMING BLVD NE APT 21-306, ALBUQUERQUE, NM 87111-9414
(505) 450-5010
Mailing address
PO BOX 484, JARALES, NM 87023-0484
(505) 450-5010
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/13/2022
Last updated
04/13/2022
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