Provider Demographics
NPI:1013214154
Name:GLOVER, SHANNON (ST)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW VESPER ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3219
Mailing Address - Country:US
Mailing Address - Phone:816-224-1300
Mailing Address - Fax:816-224-1310
Practice Address - Street 1:1801 NW VESPER ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3219
Practice Address - Country:US
Practice Address - Phone:816-224-1300
Practice Address - Fax:816-224-1310
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist