Provider Demographics
NPI:1043475585
Name:MARIE, SHANNON (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:MARIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:AIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4015 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5028
Mailing Address - Country:US
Mailing Address - Phone:509-736-4005
Mailing Address - Fax:509-737-9525
Practice Address - Street 1:4015 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5028
Practice Address - Country:US
Practice Address - Phone:509-736-4005
Practice Address - Fax:509-737-9525
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60043875237600000X, 231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter