Provider Demographics
NPI:1720754187
Name:WILLIAMSON, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WILLIAMSON
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 1:7209 LONGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2209
Mailing Address - Country:US
Mailing Address - Phone:513-502-0882
Mailing Address - Fax:
Practice Address - Street 1:1797 KING AVE
Practice Address - Street 2:
Practice Address - City:KINGS MILLS
Practice Address - State:OH
Practice Address - Zip Code:45034-1751
Practice Address - Country:US
Practice Address - Phone:513-398-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20211783-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist