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General NPI Number Information
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NPI Number | 1770873218
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Entity Type | Individual
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Provider Name | SUSAN ELLEN SHANKER MFT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 1811 SANTA RITA RD SUITE NUMBER 220
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City | PLEASANTON
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State | CA
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Zip | 94566-4746
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Country | US
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Telephone | 925-462-1111
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Fax | 925-461-6633
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Provider Business Mailing Address
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Address Line | 1061 RIESLING DR
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City | PLEASANTON
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State | CA
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Zip | 94566-7221
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Country | US
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Telephone | 925-462-1111
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Fax | 925-461-6633
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 17577
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License Number State | CA
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