Healthcare Provider Details

I. General information

NPI: 1023414521
Provider Name (Legal Business Name): SHAUNDRA K PATRICK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUNDRA DRYSDALE

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 27
VERNAL UT
84078-0001
US

IV. Provider business mailing address

PO BOX 27
VERNAL UT
84078-0001
US

V. Phone/Fax

Practice location:
  • Phone: 720-934-6028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015331
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-896
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: