Provider Demographics
NPI:1669707626
Name:BAURICHTER, SHANNON MARY (MS SLP, MA ED)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARY
Last Name:BAURICHTER
Suffix:
Gender:F
Credentials:MS SLP, MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BAY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5214
Mailing Address - Country:US
Mailing Address - Phone:206-491-9195
Mailing Address - Fax:360-329-7828
Practice Address - Street 1:1230 BAY ST
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:206-491-9195
Practice Address - Fax:360-329-7828
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60113015235Z00000X
WA60174701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist