Provider Demographics
NPI:1619445434
Name:KONTYKO, SHANNON PROPST (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PROPST
Last Name:KONTYKO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:KATE
Other - Last Name:PROPST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:510 ASHBY ST.
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836
Mailing Address - Country:US
Mailing Address - Phone:304-530-2348
Mailing Address - Fax:304-530-2340
Practice Address - Street 1:510 ASHBY ST.
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836
Practice Address - Country:US
Practice Address - Phone:304-530-2348
Practice Address - Fax:304-530-2340
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08429235Z00000X
WVSLP-2021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist