Provider Demographics
NPI:1598027278
Name:PERRITON, SHANNON ELLEN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELLEN
Last Name:PERRITON
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 1:1602 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4065
Mailing Address - Country:US
Mailing Address - Phone:307-871-7590
Mailing Address - Fax:
Practice Address - Street 1:1602 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4065
Practice Address - Country:US
Practice Address - Phone:307-871-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management