Provider Demographics
NPI:1750626420
Name:GAISER, SHANNON ANN (LPC, NCC, CAC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ANN
Last Name:GAISER
Suffix:
Gender:F
Credentials:LPC, NCC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FALLECKER RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-0027
Mailing Address - Country:US
Mailing Address - Phone:724-256-6829
Mailing Address - Fax:
Practice Address - Street 1:20399 ROUTE 19
Practice Address - Street 2:BRANDT DR, ONE LANDMARK NORTH
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6134
Practice Address - Country:US
Practice Address - Phone:724-816-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional