Provider Demographics
NPI:1013162288
Name:NEIER, SHANNON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:NEIER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PORTERFORD RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-3910
Mailing Address - Country:US
Mailing Address - Phone:314-402-6633
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:MO
Practice Address - Zip Code:63013-1509
Practice Address - Country:US
Practice Address - Phone:636-583-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MOMO 2007025057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist