Provider Demographics
NPI:1679064786
Name:SCOTT-BOWKER, SHANNON GAIL
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:GAIL
Last Name:SCOTT-BOWKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 NORTHBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-2144
Mailing Address - Country:US
Mailing Address - Phone:815-342-1909
Mailing Address - Fax:
Practice Address - Street 1:1301 WHITEHEAD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-7235
Practice Address - Country:US
Practice Address - Phone:804-745-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist