Provider Information for 1205175288
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Mrs. SHANNON LYNN BARTLETT MSW, LCSWA
Other Names:Former Name:Ms. SHANNON LYNN BUCKALEW MSWSex: Female
NPI: 1205175288
Last Updated: 2013-06-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1205175288 | ||||||||||||
| Enumeration Date | 2013-02-11 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 301 MEDICAL PARK DR SUITE 202-B CONCORD, NC 28025-2981 United States Phone: 704-403-2692 | Fax: | ||||||||||||
| Primary Practice Address | 301 MEDICAL PARK DR SUITE 202-B CONCORD, NC 28025-2981 United States Phone: 704-403-2692 | Fax: | ||||||||||||
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