Provider Demographics
NPI:1518134857
Name:SHANAHAN, CHERI (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NELSON RD APT W103
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9345
Mailing Address - Country:US
Mailing Address - Phone:720-494-2557
Mailing Address - Fax:
Practice Address - Street 1:2727 NELSON RD APT W103
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9345
Practice Address - Country:US
Practice Address - Phone:720-494-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46107517Medicaid