Individual
SHAUNNA LYNN WATHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2715 INDUSTRIAL ST, JUNCTION CITY, KS 66441-8398
(785) 256-9096
Mailing address
23135 CARRIAGE ST APT 2, FORT RILEY, KS 66442-2403
(758) 492-3130
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RBT-19-81760
—
KS
Enumeration date
03/21/2019
Last updated
03/21/2019
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