Provider Demographics
NPI:1295492718
Name:MCINTIRE, SHANNON (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCINTIRE
Suffix:
Gender:F
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 1:1835 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-6883
Mailing Address - Country:US
Mailing Address - Phone:360-774-0480
Mailing Address - Fax:
Practice Address - Street 1:350 W FIR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3352
Practice Address - Country:US
Practice Address - Phone:360-582-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14338404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist