Provider Demographics
NPI:1538809645
Name:RUTHER-PRESCOTT, SHANNON CHRISTINE (RTT PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:RUTHER-PRESCOTT
Suffix:
Gender:F
Credentials:RTT PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10583 ACACIA PARK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1243
Mailing Address - Country:US
Mailing Address - Phone:702-908-1414
Mailing Address - Fax:
Practice Address - Street 1:10583 ACACIA PARK PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1243
Practice Address - Country:US
Practice Address - Phone:702-908-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty