Provider Demographics
NPI:1003077017
Name:WILLIAMS, SHANNON L (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:L
Other - Last Name:JETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6509 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8209
Mailing Address - Country:US
Mailing Address - Phone:972-781-1462
Mailing Address - Fax:972-378-4125
Practice Address - Street 1:6509 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8209
Practice Address - Country:US
Practice Address - Phone:972-781-1462
Practice Address - Fax:972-378-4125
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51712237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1470180Medicaid
LA1470180Medicaid