Healthcare Provider Details

I. General information

NPI: 1689367419
Provider Name (Legal Business Name): SHANNON LEAH MUELA SLPD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

IV. Provider business mailing address

30350 DESERT PALM DR
THOUSAND PALMS CA
92276-4338
US

V. Phone/Fax

Practice location:
  • Phone: 760-883-2700
  • Fax:
Mailing address:
  • Phone: 760-898-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number34768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: