MEDICARE: MRS. SHANNON REBECCA WHEELER M.A., CCC-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
1	235Z00000X	Speech-Language Pathologist	SL014903	PA
2	235Z00000X	Speech-Language Pathologist	1750926333	VA

General Provider Information

NPI Number	:	1750926333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON REBECCA WHEELER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-1403
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	2 PENN BLVD STE 220
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1403
Country	:	US
Telephone Number	:	215-844-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	06/25/2021

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Directions to “ MRS. SHANNON REBECCA WHEELER M.A., CCC-SLP” Practice Location

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