Provider Demographics
NPI:1346489044
Name:YOUNG, SHANNON JEANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JEANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2014
Mailing Address - Country:US
Mailing Address - Phone:952-544-0812
Mailing Address - Fax:952-544-0824
Practice Address - Street 1:11700 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2014
Practice Address - Country:US
Practice Address - Phone:952-544-0812
Practice Address - Fax:952-544-0824
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist