Provider Demographics
NPI:1801464367
Name:SHANNON, NATALIE DANIELLE (MT-BC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:DANIELLE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22917 106TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3365
Mailing Address - Country:US
Mailing Address - Phone:206-552-5789
Mailing Address - Fax:
Practice Address - Street 1:22917 106TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3365
Practice Address - Country:US
Practice Address - Phone:206-552-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist