Provider Demographics
NPI:1629437611
Name:PARKER, SHANNON (AUD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:GEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A, F-AAA
Mailing Address - Street 1:1091 STATE HWY 83
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-6007
Mailing Address - Country:US
Mailing Address - Phone:806-239-5344
Mailing Address - Fax:
Practice Address - Street 1:111 N AVENUE B # 1242
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-3115
Practice Address - Country:US
Practice Address - Phone:806-592-7030
Practice Address - Fax:806-592-7028
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51763231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist