Provider Demographics
NPI:1427376094
Name:TARRH, SHANNON (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:TARRH
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 1:3017 TIM TAM TRL
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-9175
Mailing Address - Country:US
Mailing Address - Phone:765-237-1466
Mailing Address - Fax:
Practice Address - Street 1:3017 TIM TAM TRL
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-9175
Practice Address - Country:US
Practice Address - Phone:765-237-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003229A235Z00000X
KY235Z00000X
KY141177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY141177OtherSTATE LICENCE NUMBER