Provider Demographics
NPI:1912191065
Name:VINCENT, SHANNON LEIGH (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEIGH
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 WAYZATA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2058
Mailing Address - Country:US
Mailing Address - Phone:952-746-3011
Mailing Address - Fax:952-746-3012
Practice Address - Street 1:11210 WAYZATA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2058
Practice Address - Country:US
Practice Address - Phone:952-746-3011
Practice Address - Fax:952-746-3012
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7789231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist