| NPI | 1386096790 |
|---|---|
| Former Name | SHANNON FLEETWOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2016027520) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 10002) |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2017-05-04 |