Provider Demographics
NPI:1235597113
Name:PARKER, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3042
Mailing Address - Country:US
Mailing Address - Phone:563-583-7357
Mailing Address - Fax:888-243-3455
Practice Address - Street 1:2175 LEXINGTON BLVD
Practice Address - Street 2:BUILDING 2
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9108
Practice Address - Country:US
Practice Address - Phone:319-653-6161
Practice Address - Fax:319-863-1311
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist