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General NPI Number Information
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NPI Number | 1376369538
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Entity Type | Individual
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Provider Name | SHONEE ALESA THEAMAN CSWC
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1150 N 25TH ST STE E
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6561
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Country | US
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Telephone | 970-433-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 SPANISH HILLS CT
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-9766
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Country | US
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Telephone | 775-223-5115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0000002349
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License Number State | CO
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