Provider Demographics
NPI:1639330863
Name:WILKINSON, SHANNON ELAINE (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ELAINE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:ELAINE
Other - Last Name:COURVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1346 S MORLEY
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270
Mailing Address - Country:US
Mailing Address - Phone:660-263-5488
Mailing Address - Fax:660-263-5750
Practice Address - Street 1:1346 S MORLEY
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270
Practice Address - Country:US
Practice Address - Phone:660-263-5488
Practice Address - Fax:660-263-5750
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008009028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist