Provider Demographics
NPI:1760110985
Name:EDELMAN, SHANNON MARIE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 ADAMS AVE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4736
Mailing Address - Country:US
Mailing Address - Phone:801-479-3346
Mailing Address - Fax:801-479-0725
Practice Address - Street 1:5349 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4736
Practice Address - Country:US
Practice Address - Phone:801-479-3346
Practice Address - Fax:801-479-0725
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT231H00000X
UT12852693-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist