Provider Demographics
NPI:1477861011
Name:ADAMS, SHANNON DOREEN (MA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DOREEN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:DOREEN
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:20030 VERNER CT
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9222
Mailing Address - Country:US
Mailing Address - Phone:530-526-4460
Mailing Address - Fax:530-529-1077
Practice Address - Street 1:6512 WESTSIDE RD STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-4868
Practice Address - Country:US
Practice Address - Phone:530-229-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 15438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist