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General NPI Number Information
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NPI Number | 1790647485
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Entity Type | Individual
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Provider Name | SHANNON WATTERS
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1930 S ALMA SCHOOL RD STE A206
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City | MESA
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State | AZ
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Zip | 85210-3066
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Country | US
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Telephone | 480-779-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 W JUANITA AVE
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City | GILBERT
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State | AZ
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Zip | 85233-2560
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Country | US
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Telephone | 480-779-9050
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-21947
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License Number State | AZ
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