Provider Demographics
NPI:1740586684
Name:VOOR, SHANNON SEBASTIAN (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:SEBASTIAN
Last Name:VOOR
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-582-7484
Mailing Address - Fax:502-582-7646
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT 6TH FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-582-7484
Practice Address - Fax:502-582-7646
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-05-25
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Provider Licenses
StateLicense IDTaxonomies
KY0966103G00000X
IN20041025A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89340079Medicaid
KY000000710020OtherANTHEM BC/BS
IN200127590Medicaid
KYP400037599Medicare Oscar/Certification