Provider Demographics
NPI:1033496617
Name:GOWER, SHANNON (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:GOWER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EAGLE RD STE 1225
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6355
Mailing Address - Country:US
Mailing Address - Phone:208-489-5999
Mailing Address - Fax:208-489-4089
Practice Address - Street 1:520 S EAGLE RD STE 1225
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6355
Practice Address - Country:US
Practice Address - Phone:208-489-5999
Practice Address - Fax:208-489-4089
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1104231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist