Provider Demographics
NPI:1528526092
Name:SHANNON, ABBY ANNE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:ANNE
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1836
Mailing Address - Country:US
Mailing Address - Phone:416-752-1585
Mailing Address - Fax:641-752-9665
Practice Address - Street 1:9 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1836
Practice Address - Country:US
Practice Address - Phone:641-752-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA005823Medicaid