| Doctor Name: | MS. SHONTAY MARIE ROE |
| NPI Number: | 1093142630 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW; PCSW |
| License Number: | PCSW-462 |
| Business Practice Address: | 1277 N 15th St Laramie, WY - 820722343 |
| Business Phone Number: | 3077426898 |
| Business Fax Number: | 3077458259 |
| Mailing Address: | 1277 N 15th St, LARAMIE |
| State: | WY |
| Postal Code: | 820722343 |
| Phone Number: | 3077426898 |
| Fax Number: | 3077458259 |
| NPI Enumeration Date: | 09/27/2013 |
| NPI Last Update Date: | 09/27/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | PCSW-462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |