Provider Demographics
NPI:1609226661
Name:SHANNON, CLAUDIA (MA CCC-S)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MA CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 ROUNDTREE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3886
Mailing Address - Country:US
Mailing Address - Phone:913-461-4715
Mailing Address - Fax:
Practice Address - Street 1:5405 ROUNDTREE ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3886
Practice Address - Country:US
Practice Address - Phone:913-461-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist