Provider Demographics
NPI:1639486624
Name:MEDLIN, SHANNON PARKER (MSP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PARKER
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 NATURE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-9754
Mailing Address - Country:US
Mailing Address - Phone:803-260-7833
Mailing Address - Fax:
Practice Address - Street 1:1115 NATURE LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-9754
Practice Address - Country:US
Practice Address - Phone:803-260-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist