Provider Demographics
NPI:1033322003
Name:PRESLEY, SHANNON R
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W SYCAMORE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76203-5010
Mailing Address - Country:US
Mailing Address - Phone:940-369-7497
Mailing Address - Fax:940-369-7702
Practice Address - Street 1:13601 LOST SPURS RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-4506
Practice Address - Country:US
Practice Address - Phone:817-874-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist