Provider Demographics
NPI:1952712804
Name:MANCINI, SHANNON J (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:J
Last Name:MANCINI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:J
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4736
Mailing Address - Country:US
Mailing Address - Phone:509-559-3100
Mailing Address - Fax:509-328-7528
Practice Address - Street 1:3754 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-559-3100
Practice Address - Fax:509-328-7528
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health