MRS. Shannon Lynn Stallworth, L.M.T,NCTMB

NPI #1013190297 in Mattoon, Illinois

Provider Information

NPI Number: 1013190297
Entity Type: Individual
Name: MRS. Shannon Lynn Stallworth, L.M.T,NCTMB
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: L.M.T,NCTMB
Enumeration Date: Dec 11, 2007
Last Updated: Dec 11, 2007

Practice Location

Address: 921 LAKE LAND BLVD
City: Mattoon
State: Illinois
ZIP Code: 61938-5521
Phone: (217) 235-3100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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