Provider Demographics
NPI:1487273298
Name:PRICE, SHANNON PENNY (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:PENNY
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 MAYBECK PLACE
Mailing Address - Street 2:CONDO C
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-272-2807
Mailing Address - Fax:
Practice Address - Street 1:4465 MAYBECK PLACE
Practice Address - Street 2:CONDO C
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-272-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5193644-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty