Healthcare Provider Details

I. General information

NPI: 1477861011
Provider Name (Legal Business Name): SHANNON DOREEN ADAMS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON DOREEN HATFIELD M.A.

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

20030 VERNER CT
RED BLUFF CA
96080-9222
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 530-526-4460
  • Fax: 530-529-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 15438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: