Provider Demographics
NPI:1770124174
Name:KAPLAN, SHANNON (MS-CCC SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KAPLAN
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 1:23185 SW JAQUITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9430
Mailing Address - Country:US
Mailing Address - Phone:503-314-3176
Mailing Address - Fax:971-281-2225
Practice Address - Street 1:23185 SW JAQUITH RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9430
Practice Address - Country:US
Practice Address - Phone:503-314-3176
Practice Address - Fax:971-281-2225
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61006623235Z00000X
OR016412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist