Most Relevant Information
Provider Data
| NPI Number: | 1003648460 |
| Provider Name: | SHANNON MOGUEL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | CB388110 |
Most Important Dates
| Enumeration Date: | 08/15/2024 |
| Last Updated: | 08/15/2024 |
Provider Practice Location
16821 SE MCGILLIVRAY BLVD STE 100
VANCOUVER
WA
986830401
Practice Location Phone/Fax
| Phone: | 3608189593 |
| Fax: | 3608281001 |
Provider Mailing Location
16821 SE MCGILLIVRAY BLVD STE 100
VANCOUVER
WA
986830401
Provider Mailing Phone/Fax
| Phone: | 3608189593 |
| Fax: | 3608281001 |