Provider Demographics
NPI:1720311970
Name:GWILLIAM, SHANNA (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:GWILLIAM
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 1:11075 S STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5164
Mailing Address - Country:US
Mailing Address - Phone:801-928-4964
Mailing Address - Fax:801-606-7038
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:SUITE 16
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-928-4964
Practice Address - Fax:801-606-7038
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical