MEDICARE: SHANNON LATIMORE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator	NV
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235587486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LATIMORE

Provider Business Mailing Address
First Line	:	3055 S NELLIS BLVD APT 2017
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7705
Country	:	US
Telephone Number	:	612-239-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 S NELLIS BLVD APT 2017
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	612-239-1500
Fax Number	:

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

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/22/2018

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Directions to “ SHANNON LATIMORE ” Practice Location

Language	Start Address	Practice Location

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