Provider Demographics
NPI:1669768669
Name:FILIPPONI, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FILIPPONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W EVERGREEN AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2682
Mailing Address - Country:US
Mailing Address - Phone:312-975-3928
Mailing Address - Fax:888-972-7531
Practice Address - Street 1:811 W EVERGREEN AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2682
Practice Address - Country:US
Practice Address - Phone:312-975-3928
Practice Address - Fax:888-972-7531
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5381235Z00000X
FLSA11709235Z00000X
IL146.013473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003733300Medicaid
FLFE967ZMedicare PIN