Most Relevant Information
Provider Data
| NPI Number: | 1003556135 |
| Provider Name: | SHANNON DOLAN |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 149024396 |
Most Important Dates
| Enumeration Date: | 03/29/2022 |
| Last Updated: | 03/29/2022 |
Provider Practice Location
7717 N ORANGE PRAIRIE RD
PEORIA
IL
616159323
Practice Location Phone/Fax
| Phone: | 3095896800 |
| Fax: |
Provider Mailing Location
809 DOGWOOD DR
WASHINGTON
IL
615712336
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |