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NPI Code Detail

MEDICARE: SHANNON WALTERS CDCA

MEDICARE: SHANNON WALTERS CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1417458472
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON WALTERS CDCA
Provider Business Mailing Address
First Line : 1127 W MAIN ST
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-3147
Country : US
Telephone Number : 740-454-1266
Fax Number : 740-454-7650
Provider Business Practice Location Address
First Line : 1127 W MAIN ST
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-3147
Country : US
Telephone Number : 740-454-1266
Fax Number : 740-454-7650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2018
Last Update Date : 11/20/2024

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Directions to “ SHANNON WALTERS CDCA” Practice Location

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