| NPI | 1841655719 |
|---|---|
| Former Name | SHANNON WALLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34008294A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 33007313A) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2023-05-02 |