Provider Demographics
NPI:1134926108
Name:ENDSLEY, SHANNON MCCANN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCCANN
Last Name:ENDSLEY
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PRESCOTT BLVD APT 917
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6618
Mailing Address - Country:US
Mailing Address - Phone:337-704-1008
Mailing Address - Fax:
Practice Address - Street 1:202 RUE IBERVILLE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3295
Practice Address - Country:US
Practice Address - Phone:337-704-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist