Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043517964 |
---|---|
Provider Name | Mrs. Shalonda Guillory |
First Address | Las Vegas, NV 89139-6861 |
Second Address | Las Vegas, NV 89139-6861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2011 |
Last Update Date | 04/11/2015 |