Provider Demographics
NPI:1689448482
Name:MANCE, SHANNON ANN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANN
Last Name:MANCE
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 1:24015 S BAY TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-8173
Mailing Address - Country:US
Mailing Address - Phone:815-370-7316
Mailing Address - Fax:
Practice Address - Street 1:24015 S BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-8173
Practice Address - Country:US
Practice Address - Phone:815-370-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist