Healthcare Provider Details

I. General information

NPI: 1417458472
Provider Name (Legal Business Name): SHANNON WALTERS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 W MAIN ST
ZANESVILLE OH
43701-3147
US

IV. Provider business mailing address

1127 W MAIN ST
ZANESVILLE OH
43701-3147
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-1266
  • Fax: 740-454-7650
Mailing address:
  • Phone: 740-454-1266
  • Fax: 740-454-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: