Provider Demographics
NPI:1841356565
Name:SMITH, SHANNON MITCHELL (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MITCHELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:MITCHELL
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:8005 FALLMEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6850
Mailing Address - Country:US
Mailing Address - Phone:972-342-9513
Mailing Address - Fax:
Practice Address - Street 1:8005 FALLMEADOW CIR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6850
Practice Address - Country:US
Practice Address - Phone:972-342-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist