Provider Demographics
NPI:1982679445
Name:SHANNON, KRISTEN MAHONEY (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MAHONEY
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAW 9A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-1971
Mailing Address - Fax:617-726-9418
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 9A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1971
Practice Address - Fax:617-726-9418
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS