MEDICARE: MRS. SHANNON E THOMAS 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
1	175T00000X	Peer Specialist
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	177469	OH

General Provider Information

NPI Number	:	1639729825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON E THOMAS CDCA

Provider Business Mailing Address
First Line	:	17837 TR 1182
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812
Country	:	US
Telephone Number	:	740-294-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	17837 TOWNSHIP ROAD 1182
Second Line	:
City	:	COSHOCTON
State	:	OH
Zip	:	43812-9340
Country	:	US
Telephone Number	:	740-294-7192
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	11/30/2021

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