Provider Demographics
NPI:1831288083
Name:BOWLING, SHANNON MICHELLE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-3925
Mailing Address - Country:US
Mailing Address - Phone:972-816-3864
Mailing Address - Fax:
Practice Address - Street 1:4500 BISSONNET ST STE 340
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3009
Practice Address - Country:US
Practice Address - Phone:713-838-9050
Practice Address - Fax:713-838-0926
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103101OtherSTATE LICENSE