Provider Demographics
NPI:1033210976
Name:EBERT, SHANNA L (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:L
Last Name:EBERT
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 HYACINTH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1757
Mailing Address - Country:US
Mailing Address - Phone:513-257-8209
Mailing Address - Fax:
Practice Address - Street 1:663 HYACINTH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1757
Practice Address - Country:US
Practice Address - Phone:519-257-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2961235Z00000X
OHSP7624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist