Provider Demographics
NPI:1841832128
Name:STANCER, SHANNON LEE ANN (LAC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE ANN
Last Name:STANCER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:LINN VALLEY
Mailing Address - State:KS
Mailing Address - Zip Code:66040-5455
Mailing Address - Country:US
Mailing Address - Phone:913-337-1433
Mailing Address - Fax:
Practice Address - Street 1:710 W 8TH ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2404
Practice Address - Country:US
Practice Address - Phone:785-893-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1647101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)