Provider Information for 1740829092
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SHANNA JANE MUIR LCPC
Sex: Female
NPI: 1740829092
Last Updated: 2023-04-19
Certification Date: 2023-04-19
Certification Date: 2023-04-19
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740829092 | ||||||||||||
| Enumeration Date | 2020-01-03 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4304 W LORA ANN LN PEORIA, IL 61615-2457 United States Phone: 309-210-6767 | Fax: | ||||||||||||
| Primary Practice Address | 4304 W LORA ANN LN PEORIA, IL 61615-2457 United States Phone: 309-210-6767 | Fax: | ||||||||||||
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