Provider Demographics
NPI:1558866632
Name:MAHAN, SHANNON WILLIAMSOM (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:WILLIAMSOM
Last Name:MAHAN
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 1:8800 KATY FWY STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1698
Mailing Address - Country:US
Mailing Address - Phone:713-574-1373
Mailing Address - Fax:713-574-3216
Practice Address - Street 1:8800 KATY FWY STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1698
Practice Address - Country:US
Practice Address - Phone:713-574-1373
Practice Address - Fax:713-574-3216
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist