Healthcare Provider Details

I. General information

NPI: 1275097032
Provider Name (Legal Business Name): MS. SHANNON LEE SLEMROD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 180
CHICO CA
95926-2460
US

IV. Provider business mailing address

1259 GLENSHIRE LN
CHICO CA
95973-5606
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-2810
  • Fax:
Mailing address:
  • Phone: 248-872-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: