Provider Demographics
NPI:1881735801
Name:SCAVARELLI, SHANNON ELAINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELAINE
Last Name:SCAVARELLI
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 E MINE CREEK RD
Mailing Address - Street 2:1161
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6256
Mailing Address - Country:US
Mailing Address - Phone:480-266-8777
Mailing Address - Fax:
Practice Address - Street 1:2725 E MINE CREEK RD
Practice Address - Street 2:1161
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-6256
Practice Address - Country:US
Practice Address - Phone:480-502-7726
Practice Address - Fax:480-513-4628
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ947137Medicaid