Provider Demographics
NPI:1588010623
Name:ISAACSON, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ISAACSON
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 1:12701 N PENNSYLVANIA AVE
Mailing Address - Street 2:APT 266
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9451
Mailing Address - Country:US
Mailing Address - Phone:405-223-9239
Mailing Address - Fax:
Practice Address - Street 1:12701 N PENNSYLVANIA AVE
Practice Address - Street 2:APT 266
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9451
Practice Address - Country:US
Practice Address - Phone:405-223-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator