Provider Demographics
NPI:1790512879
Name:BAUGH, SHANNONDOA
Entity type:Individual
Prefix:
First Name:SHANNONDOA
Middle Name:
Last Name:BAUGH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JUNIPER
Other - Middle Name:
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:735 7TH ST SE APT 215
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3817
Mailing Address - Country:US
Mailing Address - Phone:206-717-1635
Mailing Address - Fax:
Practice Address - Street 1:7440 W MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4141
Practice Address - Country:US
Practice Address - Phone:206-772-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor