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NPI Code Detail

MEDICARE: SHANNON RAY

MEDICARE: SHANNON RAY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1285577031
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON RAY
Provider Business Mailing Address
First Line : 4856 INNOVATION DR
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5539
Country : US
Telephone Number : 970-494-4200
Fax Number :
Provider Business Practice Location Address
First Line : 2260 W TRILBY RD
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-9650
Country : US
Telephone Number : 970-494-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 04/14/2026

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Directions to “ SHANNON RAY ” Practice Location

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