Provider Demographics
NPI:1679361190
Name:CLINE, SHANNON LEE (MS)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEE
Last Name:CLINE
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 TWADDELL DR
Mailing Address - Street 2:
Mailing Address - City:UPPR CHICHSTR
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3547
Mailing Address - Country:US
Mailing Address - Phone:716-704-8358
Mailing Address - Fax:
Practice Address - Street 1:1108 TWADDELL DR
Practice Address - Street 2:
Practice Address - City:UPPR CHICHSTR
Practice Address - State:PA
Practice Address - Zip Code:19061-3547
Practice Address - Country:US
Practice Address - Phone:716-704-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty