MEDICARE: MS. SHANNON MARY RUANE M.S., CRC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC003801	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225130727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON MARY RUANE M.S., CRC, LPC

Provider Business Mailing Address
First Line	:	522 HARBOUR DR
Second Line	:	APT C1
City	:	BENSALEM
State	:	PA
Zip	:	19020-7021
Country	:	US
Telephone Number	:	215-244-0845
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAND TITLE BLDG
Second Line	:	100 S. BROAD STREET, SUITE 1309
City	:	PHILADELPHIA
State	:	PA
Zip	:	19110-1023
Country	:	US
Telephone Number	:	215-244-0845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	06/18/2008

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