Provider Demographics
NPI:1841097268
Name:MANJANG, SHANNA RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:RUTH
Last Name:MANJANG
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:RUTH
Other - Last Name:CAPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:949 E 12400 S STE A2
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9333
Mailing Address - Country:US
Mailing Address - Phone:385-524-6665
Mailing Address - Fax:
Practice Address - Street 1:949 E 12400 S STE A2
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9333
Practice Address - Country:US
Practice Address - Phone:385-524-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT358365-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical