Provider Demographics
NPI:1821709668
Name:DUFFY, SHANNON M (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:DUFFY
Suffix:
Gender:F
Credentials:CCC-SLP
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Mailing Address - Street 1:395 EDWARD J ROY DR APT 209
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4155
Mailing Address - Country:US
Mailing Address - Phone:603-620-9996
Mailing Address - Fax:
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2193
Practice Address - Country:US
Practice Address - Phone:978-937-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH2228235Z00000X
MA78053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA78053OtherBOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
NH2228OtherOFFICE OF LICENSED ALLIED HEALTH PROFESSIONALS
14394506OtherAMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION