Provider Demographics
NPI:1043525553
Name:CAMPBELL, SHANNA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARIE
Last Name:CAMPBELL
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-0428
Mailing Address - Country:US
Mailing Address - Phone:660-425-2211
Mailing Address - Fax:
Practice Address - Street 1:2600 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2701
Practice Address - Country:US
Practice Address - Phone:660-425-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist