Provider Demographics
NPI:1760237689
Name:MORRISSETTE, SHANNON PAGE (HIS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAGE
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:PAGE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:415 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993-1245
Mailing Address - Country:US
Mailing Address - Phone:219-286-2221
Mailing Address - Fax:765-446-8168
Practice Address - Street 1:2825 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-1701
Practice Address - Country:US
Practice Address - Phone:765-447-0131
Practice Address - Fax:765-446-8168
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001635A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist