Healthcare Provider Details

I. General information

NPI: 1598109308
Provider Name (Legal Business Name): SHANNON LESLIE MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LESLIE MORGAN ASW

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 12/15/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 GREENHAVEN DR STE 202
SACRAMENTO CA
95831-5640
US

IV. Provider business mailing address

11615 ARNO RD
WILTON CA
95693-8550
US

V. Phone/Fax

Practice location:
  • Phone: 916-422-2556
  • Fax:
Mailing address:
  • Phone: 916-519-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: