Shannon Dee Wassam
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Smithton, MO
NPI 1356465033 · NPPES record last updated Oct 7, 2014
Key facts
- NPI
- 1356465033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Practice address
- 308 E Smith St
Smithton, MO 65350-1079 - Phone
- (660) 343-3681
- Fax
- (660) 343-5871
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lasting Impressions Group Home | Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
308 E Smith St
Smithton, MO 65350-1079
Mailing address
PO Box 513
308 E Smith
Smithton, MO 65350-0513
Phone (660) 343-3681
Other providers in Smithton, MO
- Lasting Impressions Group Home
- Ronald J Hicken
- Sandra Ross
- School District R 6 Smithton
- Melissa Walsh
All providers in Smithton, MO · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.