Healthcare Provider Details

I. General information

NPI: 1326566233
Provider Name (Legal Business Name): SHANNON PRITCHETT MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 BLUFFVIEW LN
DUPO IL
62239-1483
US

IV. Provider business mailing address

1501 PELHAM PT
SWANSEA IL
62226-5994
US

V. Phone/Fax

Practice location:
  • Phone: 618-286-3311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146013031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: