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NPI Code Detail

MEDICARE: SHANNON CLOUSE

MEDICARE: SHANNON CLOUSE
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 : 1740096346
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON CLOUSE
Provider Business Mailing Address
First Line : 622 N 900 W
Second Line :
City : ARLINGTON
State : IN
Zip : 46104-9482
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 120 W JACKSON ST
Second Line :
City : SHELBYVILLE
State : IN
Zip : 46176-1295
Country : US
Telephone Number : 317-512-2101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 12/09/2024

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Directions to “ SHANNON CLOUSE ” Practice Location

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