Provider Demographics
NPI:1275967457
Name:STEVENS, SHANNON L (MSTCM, LAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BELLAIRE ST
Mailing Address - Street 2:#105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6205
Mailing Address - Country:US
Mailing Address - Phone:303-912-6420
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 810
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:303-912-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00001873171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist