Provider Demographics
NPI:1386219798
Name:WILLISON, SHAWN DESTINY
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DESTINY
Last Name:WILLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19585 HESS RD STE C6
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3891
Mailing Address - Country:US
Mailing Address - Phone:720-642-7019
Mailing Address - Fax:
Practice Address - Street 1:19585 HESS RD STE C6
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3891
Practice Address - Country:US
Practice Address - Phone:720-642-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician