Provider Demographics
NPI:1669032736
Name:STIGALL, SHANNON GLYNN DANIELS (SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:GLYNN DANIELS
Last Name:STIGALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GREENBELT CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9216
Mailing Address - Country:US
Mailing Address - Phone:302-668-6019
Mailing Address - Fax:
Practice Address - Street 1:115 GREENBELT CT
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9216
Practice Address - Country:US
Practice Address - Phone:302-668-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist