Provider Demographics
NPI:1376242370
Name:SWEAT-TANGARO, 016103 SHANNON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:016103
Middle Name:SHANNON
Last Name:SWEAT-TANGARO
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 1:420 N 200 W
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1207
Mailing Address - Country:US
Mailing Address - Phone:801-578-8231
Mailing Address - Fax:
Practice Address - Street 1:420 N 200 W
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84103-1207
Practice Address - Country:US
Practice Address - Phone:801-578-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9276944-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist