Provider Demographics
NPI:1114177458
Name:PARKER, SHANNON T (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RENEE'
Other - Last Name:TYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:366 DANIELS RD
Mailing Address - Street 2:
Mailing Address - City:CORAPEAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27926-9699
Mailing Address - Country:US
Mailing Address - Phone:252-339-2835
Mailing Address - Fax:
Practice Address - Street 1:366 DANIELS RD
Practice Address - Street 2:
Practice Address - City:CORAPEAKE
Practice Address - State:NC
Practice Address - Zip Code:27926-9699
Practice Address - Country:US
Practice Address - Phone:252-339-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12106895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist