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General NPI Number Information
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NPI Number | 1982527743
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Entity Type | Individual
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Provider Name | SHANAN FARRIS
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Gender | Female
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 1242 FOURIER DR
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City | MADISON
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State | WI
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Zip | 53717-1968
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Country | US
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Telephone | 608-662-9327
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Fax | 608-662-9041
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Provider Business Mailing Address
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Address Line | 1600 W 41ST ST STE 500
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City | BALTIMORE
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State | MD
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Zip | 21211-1504
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Country | US
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Telephone | 410-369-0000
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Fax | 410-484-3129
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1572
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License Number State | WI
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