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NPI Code Detail

MEDICARE: MRS. SHANNON E KOLAWOLMAY MS

MEDICARE: MRS. SHANNON E KOLAWOLMAY MS
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 Pathologist08955MD

General Provider Information

NPI Number : 1770054132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON E KOLAWOLMAY MS
Provider Business Mailing Address
First Line : 1159 DAFFODIL DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-6195
Country : US
Telephone Number : 570-780-2473
Fax Number :
Provider Business Practice Location Address
First Line : 125 N COURT ST
Second Line :
City : WESTMINSTER
State : MD
Zip : 21157-5192
Country : US
Telephone Number : 410-751-3033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2018
Last Update Date : 08/30/2021

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