Provider Demographics
NPI:1528468170
Name:HSU, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9159 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4388
Mailing Address - Country:US
Mailing Address - Phone:702-797-0283
Mailing Address - Fax:
Practice Address - Street 1:9159 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4388
Practice Address - Country:US
Practice Address - Phone:702-797-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2025-02-16
Deactivation Date:2017-05-31
Deactivation Code:
Reactivation Date:2017-11-16
Provider Licenses
StateLicense IDTaxonomies
NV8715-C1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical