Provider Demographics
NPI:1568757698
Name:LEDING, SHANNON L
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:LEDING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CALAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 JOHNSON MILL BLVD
Mailing Address - Street 2:SUITE A AND B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5297
Mailing Address - Country:US
Mailing Address - Phone:479-209-1274
Mailing Address - Fax:
Practice Address - Street 1:3801 JOHNSON MILL BLVD
Practice Address - Street 2:SUITE A AND B
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5297
Practice Address - Country:US
Practice Address - Phone:479-856-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist