Healthcare Provider Details

I. General information

NPI: 1699189761
Provider Name (Legal Business Name): SHANNON M WITTER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 FAUNCE CORNER RD
NORTH DARTMOUTH MA
02747-1218
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-995-0700
  • Fax: 508-995-3070
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: