Provider Demographics
NPI:1649409608
Name:SCHUMACHER, SHANNON LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:SCHUMACHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:ADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1177 N WARSON RD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-569-2211
Mailing Address - Fax:314-569-3656
Practice Address - Street 1:1177 N. WARSON RD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-569-2211
Practice Address - Fax:314-569-3656
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist