Provider Demographics
NPI:1801004668
Name:TAVERNIER, SHANNON LYNN (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:TAVERNIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10928 PICKET FENCE PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4118
Mailing Address - Country:US
Mailing Address - Phone:317-985-9587
Mailing Address - Fax:317-595-9596
Practice Address - Street 1:10928 PICKET FENCE PL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4118
Practice Address - Country:US
Practice Address - Phone:317-985-9587
Practice Address - Fax:317-595-9596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist