Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH00010349 | WA |
NPI | 1003117862 |
---|---|
Provider Name | Mrs. Shannon Sandeno |
First Address | Seattle, WA 98144 |
Second Address | Seattle, WA 98144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |