Provider Demographics
NPI:1821241514
Name:CHILDS, SHANNON AILEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:AILEEN
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:AILEEN
Other - Last Name:AMPHLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:40 HITCHING POST RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9241
Mailing Address - Country:US
Mailing Address - Phone:406-223-4080
Mailing Address - Fax:
Practice Address - Street 1:720 STONERIDGE DR
Practice Address - Street 2:SUITE # 2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7032
Practice Address - Country:US
Practice Address - Phone:406-556-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist