Wilson, Shannon L

Wilson, Shannon L is an sole proprietor health care provider with primary practice located at 90 Hope Dr Bldg 6000 , Mountain Home Afb ID 83648-1062. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Wilson, Shannon L can be contacted via phone (208) 288-7580.

Contact Information

Primary practice address
90 Hope Dr Bldg 6000 Mountain Home Afb ID 83648-1062
Phone: (208) 288-7580
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X LCSW-36402 Idaho
Behavioral Health & Social Service Providers / Social Worker 104100000X LMSW-33063 Idaho

Profile Details

NPI number 1013396175
LBN Legal business name Wilson, Shannon L
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 22nd, 2015
Last updated Dec 1st, 2025 - about last year

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.

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