Provider Demographics
NPI:1861043978
Name:HARDEE, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HARDEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ORCHARD GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-4905
Mailing Address - Country:US
Mailing Address - Phone:618-920-7566
Mailing Address - Fax:
Practice Address - Street 1:CLAYTON ELEMENTARY
Practice Address - Street 2:510 MAIN STREET
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938
Practice Address - Country:US
Practice Address - Phone:302-653-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE04-0000627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist