JACOB R SHAW

BASIN, WY
NPI1396513719
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy175T00000X Peer Specialist
(Licence: WY  143)
Enumeration Date2023-12-14
Last Update Date2023-12-14
Business Address
JACOB R SHAW
116 SOUTH 3RD STREET
BASIN, WY 82410
Phone number: 307-568-2020
Mailing Address
JACOB R SHAW
1114 LANE 12
LOVELL, WY 82431-9555
Phone number: 307-548-6543