Provider Demographics
NPI:1417105834
Name:SNYDER, SHANNON (SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 CRESENT OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-4199
Mailing Address - Country:US
Mailing Address - Phone:865-675-5545
Mailing Address - Fax:
Practice Address - Street 1:1520 GROVE ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1575
Practice Address - Country:US
Practice Address - Phone:865-458-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP3354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist