Provider Demographics
NPI:1558129809
Name:MORALES, SHANNON R (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:MORALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:R
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:45244 32ND ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-8445
Mailing Address - Country:US
Mailing Address - Phone:661-713-6037
Mailing Address - Fax:
Practice Address - Street 1:45244 32ND ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-8445
Practice Address - Country:US
Practice Address - Phone:661-713-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor