Provider Demographics
NPI:1508129180
Name:DUKES, SHANNON MITCHELL (SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:MITCHELL
Last Name:DUKES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DENEECE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:521 CARO LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-7951
Mailing Address - Country:US
Mailing Address - Phone:803-645-4597
Mailing Address - Fax:
Practice Address - Street 1:521 CARO LANE
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7951
Practice Address - Country:US
Practice Address - Phone:864-833-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist