Provider Demographics
NPI:1013214154
Name:GLOVER, SHANNON (ST)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 NE 175TH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8274
Mailing Address - Country:US
Mailing Address - Phone:660-238-5010
Mailing Address - Fax:
Practice Address - Street 1:101 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1857
Practice Address - Country:US
Practice Address - Phone:660-238-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist