Healthcare Provider Details

I. General information

NPI: 1295937563
Provider Name (Legal Business Name): SHANNON COAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

1112 HAWTHORNE DR
SAN MATEO CA
94402-1978
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6701
  • Fax: 650-725-8102
Mailing address:
  • Phone: 650-571-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 13003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: