Provider Demographics
NPI:1679821367
Name:FISHER, SHANNA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:JUDSONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72081-9323
Mailing Address - Country:US
Mailing Address - Phone:501-729-3947
Mailing Address - Fax:
Practice Address - Street 1:3259 HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081-9323
Practice Address - Country:US
Practice Address - Phone:501-729-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist