Provider Demographics
NPI:1851533715
Name:PALOMARES, SHANNON SARMING (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:SARMING
Last Name:PALOMARES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:96 W MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3016
Mailing Address - Country:US
Mailing Address - Phone:530-668-1010
Mailing Address - Fax:530-668-9799
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:STE. B
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3016
Practice Address - Country:US
Practice Address - Phone:530-668-1010
Practice Address - Fax:530-668-9799
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist