Provider Demographics
NPI:1114584398
Name:CROSS, SHANNON BRIANNA
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BRIANNA
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:BRIANNA
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 W HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4504
Mailing Address - Country:US
Mailing Address - Phone:248-889-7600
Mailing Address - Fax:248-889-7658
Practice Address - Street 1:222 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4504
Practice Address - Country:US
Practice Address - Phone:248-889-7600
Practice Address - Fax:248-889-5876
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501008938237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104976414OtherNPI