Healthcare Provider Details

I. General information

NPI: 1295200996
Provider Name (Legal Business Name): SHANNON WOODLAND SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 S PLACENTIA AVE
PLACENTIA CA
92870-6826
US

IV. Provider business mailing address

8227 DONOVAN ST
DOWNEY CA
90242-3509
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-8318
  • Fax:
Mailing address:
  • Phone: 949-533-9238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5147
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: