Provider Demographics
NPI:1760638654
Name:SHANNON AND ASSOCIATES
Entity Type:Organization
Organization Name:SHANNON AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-297-0422
Mailing Address - Street 1:1155 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3043
Mailing Address - Country:US
Mailing Address - Phone:614-297-0422
Mailing Address - Fax:614-297-1050
Practice Address - Street 1:1155 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3043
Practice Address - Country:US
Practice Address - Phone:614-297-0422
Practice Address - Fax:614-297-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9377731Medicare PIN
OHD03992Medicare PIN