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NPI Code Detail

MEDICARE: SHANNON HEATHER FRYE SLP

MEDICARE:   SHANNON HEATHER FRYE  SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP# 1543AR

General Provider Information

NPI Number : 1285880963
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HEATHER FRYE SLP
Provider Business Mailing Address
First Line : 2307 JAYBEE DR
Second Line :
City : JONESBORO
State : AR
Zip : 72404-9417
Country : US
Telephone Number : 870-910-5831
Fax Number :
Provider Business Practice Location Address
First Line : 1606 PINE GROVE LN
Second Line :
City : HARRISBURG
State : AR
Zip : 72432-9304
Country : US
Telephone Number : 870-578-5426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 08/13/2008

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Directions to “ SHANNON HEATHER FRYE SLP” Practice Location

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