Provider Demographics
NPI:1790860021
Name:NALLEY, SHANNON LINAY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LINAY
Last Name:NALLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 LONE STAR DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-6140
Mailing Address - Country:US
Mailing Address - Phone:469-698-0780
Mailing Address - Fax:
Practice Address - Street 1:789 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4840
Practice Address - Country:US
Practice Address - Phone:972-771-5731
Practice Address - Fax:972-771-5786
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3242OtherBLUE CROSS BLUE SHIELD