Provider Demographics
NPI:1073847505
Name:WAID, SHANNON HAYNES (MCD, CCC-SLP, AVT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:HAYNES
Last Name:WAID
Suffix:
Gender:F
Credentials:MCD, CCC-SLP, AVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 COVINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6647
Mailing Address - Country:US
Mailing Address - Phone:334-319-3684
Mailing Address - Fax:
Practice Address - Street 1:2290 MOORES MILL RD
Practice Address - Street 2:SUITE #400
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8431
Practice Address - Country:US
Practice Address - Phone:334-319-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist