Provider Demographics
NPI:1679344600
Name:VOTAW, SHANNON KAY (MA, PPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KAY
Last Name:VOTAW
Suffix:
Gender:F
Credentials:MA, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 RUMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3813
Mailing Address - Country:US
Mailing Address - Phone:307-578-7770
Mailing Address - Fax:
Practice Address - Street 1:1527 RUMSEY AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3813
Practice Address - Country:US
Practice Address - Phone:307-578-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health