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NPI Code Detail

MEDICARE: SHANNON MARTIN MA

MEDICARE: SHANNON MARTIN MA
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1366162539
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MARTIN MA
Provider Business Mailing Address
First Line : 4721 S CLIFF AVE STE 103
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-6969
Country : US
Telephone Number : 816-608-1958
Fax Number : 800-687-5070
Provider Business Practice Location Address
First Line : 14155 92 HWY
Second Line :
City : PLATTE CITY
State : MO
Zip : 64079-8907
Country : US
Telephone Number : 816-916-7228
Fax Number : 800-687-5070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2022
Last Update Date : 03/07/2023

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Directions to “ SHANNON MARTIN MA” Practice Location

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