Kretz, Shannon Dwayne
Kretz, Shannon Dwayne is an individual health care provider with primary practice located at 309 Oak St , Kelso WA 98626-2340. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Kretz, Shannon Dwayne can be contacted via phone (360) 423-0203.Contact Information
Primary practice address
309 Oak St
Kelso WA 98626-2340
Phone: (360) 423-0203
Fax: (360) 577-7904
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counselor | 101Y00000X | 60871961 | Washington |
Profile Details
| NPI number | 1861977936 |
|---|---|
| LBN Legal business name | Kretz, Shannon Dwayne |
| Credentials | AA, CDPT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2018 |
| Last updated | Feb 5th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861977936 | NPPES |
| Washington | MEDICAID | 2108137 |
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